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Introduction The Mood Management Group is an integral part of the programme at the Oliver Zangwill Centre for Neuropsychological Rehabilitation. Although clients attend the Psychological Support Group and individual mood sessions, it is clear that clients experience common emotional sequelae (Williams and Evans, 2003) that benefit from a group approach. Whilst the Psychological Support Group (Chapter 9) provides a protected space and time for clients to support one another, to reflect and to apply cognitive and communication skills in a group setting, the Mood Management Group provides a ‘normalizing’, psychoeducational and strategy focused approach. The group process of sharing experiences and reflecting on how learning in rehabilitation may apply to oneself or others is still important, but is less central than in the Psychological Support Group. Practically, it enables clinicians to share a greater amount of information with clients than possible in individual sessions. As a result of this group, it is hoped that clients have a greater understanding of their own and others' emotional goals, challenges, strengths and strategies, and can share perspectives and develop self-awareness. This aims to empower individual clients so the group members can support each other more effectively. Aims of the group In the Centre policies and procedures, we describe the aim of the group as follows: The Mood Management Group is aimed at providing clients with an opportunity to develop an awareness of problems they may have in mood and behaviour and for developing skills and strategies for coping with such problems.

Introduction The Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation opened in 1996 and was modelled on the American holistic programmes developed by Yehuda Ben-Yishay and George Prigatano. It was named after Oliver Louis Zangwill, Professor of Psychology at Cambridge University between 1954 and 1984. He was also a pioneer of brain injury rehabilitation in Great Britain during the Second World War when he worked in Edinburgh with brain injured soldiers. The Centre follows many of the principles laid down by Ben-Yishay (1978), Prigatano et al . (1986) and Christensen and Teasdale (1995), and is also significantly influenced by the critical ‘scientist practitioner’ model of clinical psychology adopted in the United Kingdom. A holistic approach to brain injury rehabilitation ‘… consists of well-integrated interventions that exceed in scope, as well as in kind, those highly specific and circumscribed interventions which are usually subsumed under the term “cognitive remediation”’ (Ben-Yishay and Prigatano, 1990; p. 40). The holistic approach recognizes that it does not make sense to separate the cognitive, emotional and social consequences of brain injury as how we feel and think affects how we behave. Ben-Yishay's (1978) model follows a hierarchy of stages through which the patient or client should work in rehabilitation. These stages are engagement, awareness, mastery, control, acceptance and identity. Individual and group sessions are provided to enable patients to work through these stages. The origins of the OZC go back to 1993 when one of us (BAW) spent several weeks at Prigatano's unit in Phoenix Arizona.

The aim of neuropsychological rehabilitation is to enable people with cognitive, emotional, or behavioural deficits to achieve their maximum potential in the domains of psychological, social, leisure, vocational or everyday functioning. Describing the holistic programme devised and adopted at the world famous Oliver Zangwill Centre and embracing a broad theoretical base, incorporating a variety of frameworks, theories and models, this book proposes an integrated approach to brain injury rehabilitation by an interdisciplinary team. The coverage explains the underlying principles involved, describes the group therapies employed, highlights a selection of real case examples and reviews the outcomes measured and achieved. This book is essential reading for clinical neuropsychologists, clinical psychologists, speech and language therapists, occupational therapists, psychiatrists, neurologists, physiotherapists, social workers and nurses.

Introduction Over the past 25 years or so there have been a number of major changes in neuropsychological rehabilitation. First it is now much more of a partnership than it was in the 1970s and 80s. Then doctors, therapists and psychologists decided what patients should and could hope to achieve from rehabilitation programmes. Now we discuss with families and patients what they hope to get from rehabilitation and we try to accommodate to this at least in part. Second, rehabilitation has moved well beyond the drills and exercise approach. We no longer find it acceptable to sit people in front of a computer or workbook in the belief that such exercises will result in improved cognitive and, more importantly, social functioning. Third, rehabilitation staff now follow a goal setting approach when planning rehabilitation programmes. Clients, families and staff negotiate appropriate goals and determine how these are to be achieved. Fourth, there is increasing recognition that the cognitive, emotional, social and behavioural consequences of brain injury are interlinked and all should be addressed in the rehabilitation process. Fifth, technology is playing a larger part than ever before in helping people with cognitive deficits compensate for their problems. Sixth, it is now more widely accepted that no one model, theory or framework is sufficient to deal with the many and complex difficulties faced by people with neuropsychological impairments following an injury or insult to the brain.

The judgement of personality change following acquired brain injury (ABI) is a powerful subjective and social action, and has been shown to be associated with a range of serious psychosocial consequences. Traditional conceptualisations of personality change (e.g., Lishman, 1998) have largely derived from individualist concepts of personality (e.g., Eysenck, 1967). These assume a direct link between neurological damage and altered personhood, accounting predominantly for their judgements of change. This assumption is found as commonly in family accounts of change as in professional discourse. Recent studies and perspectives from the overlapping fields of social neuroscience, cognitive approaches to self and identity and psychosocial processes following ABI mount a serious challenge to this assumption. These collectively identify a range of direct and indirect factors that may influence the judgement or felt sense of change in personhood by survivors of ABI and their significant others. These perspectives are reviewed within a biopsychosocial framework: neurological and neuropsychological deficits, psychological mechanisms and psychosocial processes. Importantly, these perspectives are applied to generate a range of clinical interventions that were not identifiable within traditional conceptualisations of personality changes following ABI.

The cognitive sequelae of encephalitis are well documented, and it is increasingly recognised that disorders of mood and anxiety can accompany these sequelae. Loss of identity is emerging as a key theme in psychotherapeutic interventions in adjustment following acquired brain injury (ABI). Cognitive-behavioural therapy can be applied to construct a new model of the self in the context of behavioural, cognitive and social sequelae of the ABI, with consideration of pre-illness identity. Behavioural experiments, in particular, may be an effective means of redefining the meaning of current situations to create a positive sense of self. In the current paper we describe the therapeutic intervention to address anxiety and changes in identity in a woman recovering from herpes simplex viral encephalitis. The intervention highlights the need to take into account the interplay between cognitive changes, such as memory and executive function, with emotion in adjustment following herpes simplex viral encephalitis.

The dimension of family context for awareness of disability following acquired brain injury (ABI) is examined through a qualitative discourse analysis. Three participants with ABI, who were identified by clinicians and relatives as demonstrating difficulties with awareness of disability, and three relatives were interviewed. The findings highlight important contextual parameters influencing the emergence of families' accounts for disability after ABI: (1) availability of sense-making resources and use of pre-injury meanings, and (2) incongruity within family sense-making and resultant orientating, disputing and contesting of accounts within families. These findings are discussed in relation to pre-existing literature, and applications are suggested for family intervention following ABI.

Previously, the cognitive recovery of a 26 year old woman, Kate, who developed a severe encephalomyelopathy and was in a 'minimally conscious/persistent vegetative state' for 6 months was reported. After 6 months, Kate began to respond to her environment and, at 2 years post-illness, neuropsychological assessment indicated that Kate was functioning within the normal range on tests of general intellectual functioning, executive functioning and most memory functions (with the exception of visual recognition memory). Although Kate has a severe dysarthria necessitating the use of a communication board and severe physical disabilities that require her to use a wheelchair, she has demonstrated an almost complete cognitive recovery and is among a tiny percentage of minimally conscious patients to do so. This single case report describes the emotional factors central to Kate's rehabilitation. Using a newly developed model of cognitive rehabilitation as a framework, the pivotal role that emotional and psychological factors played in Kate's adjustment to the consequences of her illness and the role of psychotherapeutic intervention in facilitating this adjustment are discussed.

The application of the neuropsychoanalytic formulation of anosognosia (Kaplan-Solms & Solms, 2000) is considered in relation to an emerging literature exploring the dimension of social context for awareness of disability after acquired brain injury (ABI). The contribution of this account is understood in terms of its post-Cartesian exploration of material/neurological parameters within an interpersonal focus. A contextual elaboration of the formulation is suggested, drawing on contemporary poststructuralist applications of psychoanalysis. The value of this application is formally explored through a qualitative study of sense-making and accounting of disability after ABI. Three participants with ABI who were identified by clinicians and relatives as demonstrating difficulties with awareness of disability, and three relatives, were interviewed. The qualitative analysis of the interview material is a social-constructionist discourse-analysis approach informed by psychoanalytic concepts. The findings highligh...

Aguirre and D'Esposito (1999) suggested a taxonomy and theoretical framework for understanding topographical disorders. One of the problems they described involved egocentric disorientation, in which deficits are not strictly confined to the topographical sphere but are seen on a wide variety of visuo-spatial paradigms. Here, we report a neuropsychological investigation of MU, a person with egocentric disorientation. To test the usefulness of Aguirre and D'Esposito's framework, we administered tests which were predicted to be easy or difficult for people with egocentric disorientation to show that MU was impaired on tasks sensitive to egocentric disorientation and that he showed adequate performance on tests sensitive to other types of topographical representation. Thus MU showed normal performance on a test of recognition of famous landmarks and he could identify photographs of personally familiar places in his home town, yet he could not say how to get from a recognised building to another place in his environment. His performance fulfils the criteria for egocentric disorientation and fits the predictions derived from Aguirre and D'Esposito's views.

Acquired brain injury (ABI) commonly results in a range of interacting difficulties including regulating emotion, managing social interactions and cognitive changes. Emotional adjustment to ABI can be difficult and requires adaptation of standard psychological therapies. This article outlines a case where cognitive– behavioural therapy (CBT) was of limited effectiveness but was significantly enhanced with compassion focused therapy (CFT). This article describes Jenny, a 23-year-old woman who suffered a traumatic brain injury 3 years prior to attending rehabilitation. Jenny presented with low self-esteem and mental health difficulties. Neuropsychological assessment revealed executive functioning difficulties. Jenny entered a holistic neuropsychological rehabilitation program aimed at improving complex interacting difficulties, receiving CBT as part of this. As CBT was of limited effectiveness, reformulation of Jenny's difficulties was presented to her based on CFT. The CFT intervention employed aimed to help Jenny develop self-validation and acceptance through producing feelings of kindness and warmth. Shifting the affective textures to the self is a key process for CFT. Self-report measures of mental health and self-esteem showed positive changes and the usefulness of CFT for Jenny. Adaptations in the context of Jenny's ABI are discussed. In conclusion, CFT may be useful in conceptualising emotional responses and developing intervention in rehabilitation after ABI, especially because CFT is based on a neurophysiological model of affect regulation that pays particular attention to the importance of affiliative emotions in the regulation of threat-focused emotion and self-construction.

Methylation of primycin with methyl iodide–silver oxide in dimethylformamide gives a trimethylated urea derivative and a trimethylated guanidine derivative. The cleavage of these products by ozonolysis is described. From a study of the products derived from these reactions a structure is proposed for primycin.

The structures of secoprimycins A and C have been established by application of high resolution mass spectrometry to the secoprimycins themselves, to their chemical degradation. Similarly the carbon skeleton and the oxygenation pattern of secoprimycin B have been established, but the position of the arabinose unit associated with this fragment has been only tentatively assigned. The structure of a minor component formed along with the secoprimycins in some experiments has also been resolved by mass spectrometry. A structure is proposed for the amino-ester that yields the secoprimycins on ozonolysis and reduction.