Author: NRS Lifespan

Have you ever met someone who was diagnosed with a health problem and it seemed to take over their life? Or a person who got injured at work and had a surgery to correct it but still went out on disability a few years later? Maybe a family member whose social calendar consists of doctors appointments for evaluations, testing, bloodwork, referrals to new doctors, etc. to the point that they seldom go out because they are tired and depressed?

These are all scenarios that depict individuals who are stuck in what psychologists call “the vortex” (Bruns, Disorbio). The vortex can feel like a downward spiral. In the worst case scenario, an individual becomes defined by their illness or injury — symptoms or health problems dictate quality of life, decision-making, and sense of identity. Doctors see these patients as complex with intractable conditions. The social and emotional factors that contributed to the downward spiral (which will be discussed next) can be easily overlooked because doctors are sometimes also stuck in the vortex with patients — why are symptoms are so intense and persistent, why are they not responding to treatment, and what is the true root cause of someone’s symptoms?

This doom-and-gloom situation is not inevitable. Obviously there are many people who are not consumed by their health problems or injuries. There are layers to the vortex story which are easily broken down into some basic categories by researchers:

(1)   Illness and injury risk factors before diagnosis (e.g., unhealthy lifestyle, high stress, exposure to toxins, genetic vulnerability)

(2)   Initial coping reactions when diagnosed based on psychological and environmental risk factors (e.g., mental health history, pessimistic outlook, low levels of perseverance, lack of home support, dissatisfaction with job)

(3)   Factors blocking escape from the vortex (misdiagnosis, focusing only on the medical factors, unrealistic patient hopes of an easy fix, patient anger, lack of multidisciplinary treatment options)

(4)   Signs of an intractable condition (high complexity, merging of emotional and physical states, failure to cope with symptoms, helplessness, doctors giving up)

Psychologists can be recruited to help in all stages of the vortex. Addressing risk factors and coping mechanisms via evidence-supported psychological interventions can powerfully shift someone’s trajectory. Additionally, psychologists can support the efforts of physicians to help patients be more directly expressive, engaged and energized, realistic about outcomes, perseverant in the face of hard work, and adherent to recommendations. This presents the best case scenario for patients and doctors alike so patients can either avoid the vortex altogether or escape it. If interested in seeking consultation or treatment from a health psychologist specializing in this area, call 732-988-3441 to schedule an appointment.

Lauren Gashlin, PsyD
Clinical-Health Psychologist

Though the two come from different schools of thought, neuropsychological assessment and behavior analysis can often complement each other and help understand an individual more completely. Neuropsychological assessments are designed to evaluate brain-behavior relationships by measuring cognitive functions like memory, attention, language, and executive functioning. These assessments help identify how neurological conditions, injuries, or developmental disorders affect mental processes. On the other hand, behavior analysis focuses on observable behavior and the environmental variables that influence it.

When used together, these approaches can enhance diagnosis, treatment planning, and intervention outcomes. For example, a neuropsychological assessment could reveal deficits in working memory or impulse control, which a behavior analyst can then address through targeted behavior modification strategies. Conversely, behavior analytic data can help provide information for the neuropsychological evaluation by providing real-world evidence of how cognitive issues manifest behaviorally. By bridging the gap between brain-based assessments and behavior-based interventions, it is much easier to deliver more individualized and effective care.

If your child is receiving behavior analysis or if you would like more information regarding your child’s cognitive strengths and areas of growth, please call our office for a consultation.

Josh Tice, BA
Psychometrician & Behavioral Technician

Suicide is a major health problem worldwide, with well over 1 million of deaths per year. Suicidal thoughts are more common than suicide attempts, with the latter occurring about 10 times more frequently than completed suicides. Among the most important risk factors are depression and anxiety/other mental health disorders combined with physical diseases such as chronic pain. Compared with the general population, individuals with chronic pain have more than double the risk of suicide and significantly higher prevalence of the following disorders:

·       Depression (20.2% vs. 9.3%)

·       Posttraumatic Stress Disorder (10.7% vs. 3.3%)

·       Any anxiety disorder (35.1% vs. 18.1%)

General Risk Factors for Suicide in Patient with Chronic Pain:

·       Being unemployed/disabled

·       Poor sleep

·       History of drug use (e.g., high opioid dose/abuse)

·       Family history of suicide

·       Past suicide attempts

·       Co-occurring mental health disorder, especially depression

·       Social withdrawal

·       Family history of depression

·       Hopelessness

Pain-Specific Risk Factors for Suicide in Patient with Chronic Pain:

·       Pain location (low back, generalized)

·       High pain intensity

·       Pain duration

·       Pre-pain history of depression

·       Pain Etiology (complex regional pain syndrome, fibromyalgia)

·       Catastrophizing

·       Pain-related helplessness

·       Burdensomeness (Feeling “I’m a burden to others”)

Due to high risk of suicide in patients with comorbid depression and chronic pain, mental health assessment, including early, appropriate treatment is of paramount importance. Here at NRS/LS, we offer psychological assessment/testing and evidence-based treatments for depression/other disorders and chronic pain (e.g., Cognitive-Behavior Therapy, Medical Adjustment Counseling®, and Biofeedback). If you or someone you know struggles with symptoms of depression and chronic pain, please contact our office for a consultation.

Basia Andrejko-Gworek, Ph.D.

Clinical Psychology

Psychogenic nonepileptic seizures (PNES) often manifests with symptoms associated with epileptic seizures as a result of some form of psychological distress as opposed to abnormal brain wave activity.  Symptoms may resemble complex partial or absence seizures with atypical movements, falling, reduced attention, or staring.  Initially, this disorder is difficult to diagnose, however, it becomes more variable following negative neuroimaging, serial EEG’s, and video EEG monitoring.  Approximately 85% of patients suspected of having PNES occur when they have at least 2 normal EEG’s, with at least 2 seizures per week and nontherapeutic response to antiseizure medication.  This occurred in this individual, and thus, she was referred for comprehensive neuropsychological consultation.

This case study describes the neuropsychological consequences of a 33-year-old, Caucasian, right-handed female who was diagnosed with psychogenic nonepileptic seizures (PNES).  HC is a 33-year-old, Caucasian, married, right-handed female with 13 years of formal education.  It was noted that her “seizures” began following a 2-month history of vascular (migraine) headaches.  She was evaluated extensively by multiple medical specialists, including her primary care physician, as well as neurology, rheumatology, and ENT.  In conjunction with her vascular headaches, HC indicated that she was experiencing significant emotional decompensation secondary to work-related stress.  She underwent a cerebral MRI which was negative and nondiagnostic.  She was seen at a neurology clinic secondary to vascular headaches and seizure-like activity which was deemed psychogenic in origin.  All diagnostic studies, including a cerebral MRI, EEG, cerebral CT scan, and more importantly, video EEG monitoring (September, 2014) were negative and nondiagnostic.

Based on the above noted information, in conjunction with the persistent nature of HC’s symptoms and subjective complaints, she was referred for neuropsychological consultation to aid in developing additional diagnostic impressions and treatment recommendations.

HC’s neuropsychological test results suggested reduced cognitive efficiency and adaptive abilities as evidenced by scores on standardized neuropsychological indices.  Primary deficits were in areas of sustained attention/concentration, information processing speed, executive functions, and bilateral UE sensorimotor abilities.  Adjustment difficulties, including paranoid delusions and concomitant post-traumatic stress (PTS), contributed to the clinical picture.  The etiology for HC’s cognitive decline appears behaviorally mediated.  Personality functioning coincides with an agitated depression and an individual with paranoid delusions.  The outset of nonepileptic seizures apparently culminated from the combination of general life and work stressors.  Her diagnosis of PNES appeared reasonable especially following the extensive neurological work up which included negative neurodiagnostics including a cerebral MRI, EEG, CT scan, and VEEG monitoring.  In conclusion, nonepileptic seizures are often a primary manifestation of psychological distress.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN

Board Certified Neuropsychologist #232

Licensed Psychologist #35S100252900

Clinical neuropsychology has now been absorbed into the medical model in various settings, from private practice to different departments in the hospital. The field has grown remarkably, providing the behavioral expression of different pathological brain conditions.  Our field has been built upon an assembly of past neuropsychologist giants along with the rich integration from different disciplines of psychology.

Unfortunately, a new phenomenon has developed in clinical neuropsychology among up-and-coming residents/fellows – “Diagnose and Adios”, i.e., test, come up with a diagnosis and discharge the patient.  This perspective in more ways than one limits our potential significant contributions to medicine and downright devalues who we are in the medical continuity caring for patients.

Clinical neuropsychology consists of intake/consultation, neuropsychological examination, the “blueprint” for the basis of treatment, and follow-up with the patient and family explaining the examination results and how they will manifest themselves in real-world functioning.  Lastly, and most importantly, these three stages ultimately lead to treatment in the form of Medical Adjustment Counseling (MAC®), biofeedback, cognitive rehabilitation, family systems, support to outreach, and professional requests.  In short, the patient needs to understand what their neuropsychological issues are, what they can do about them, and how to reintegrate back into their daily life equipped with a strategy that will enable them to succeed.  Without this neuropsychological compass, they are doomed to fail.

The point is, if we merely test and conclude with a diagnosis, what happens to the patient?  Our valuable services are dismissed, and the neuropsychologist merely becomes a technician.

Here at Neuropsychology Rehabilitation Services| LifeSpan, our comprehensive residency/fellowship program provides a broadband of clinical skills from the beginning (consultation) to diagnostic accuracy (testing) and finally, treatment. The patient is followed and treated for the entirety of their neuropsychological condition. Our fellowship program is aimed at enabling the fellow to provide the best range of skills that will professionally inoculate you from being absorbed into the herd of neuropsychological mediocrity.

Give us a call if there are any questions or interest.

Robert B. Sica, Ph.D., ABN
Board-Certified in Neuropsychology
Owner, Neuropsychological Rehabilitation Services|LifeSpan
Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Psychiatry and Behavioral Health
Department of Neurology
Clinical Assistant Professor, Hackensack Meridian School of Medicine

Forgetting where you placed your keys or occasionally struggling to find the right word is common as we get older, but how can we tell the difference between normal aging and the early signs of dementia?

What’s Normal?

Mild changes in memory and processing speed are typical with age. For example:

·       Slower Recall: It may take longer to remember names or words, but they typically come to mind later.

·       Occasional Forgetfulness: Misplacing objects or briefly forgetting an appointment is common but doesn’t disrupt daily life.

·       Maintained Independence: Despite small memory lapses, daily tasks and problem-solving remain intact.

Early Signs of Dementia

Unlike normal aging, dementia involves significant cognitive decline that interferes with daily life. Warning signs include:

·       Frequent Memory Loss: Forgetting recent conversations, events, or important information without recalling it later.

·       Confusion with Time and Place: Getting lost in familiar locations or struggling to keep track of dates and times.

·       Difficulty with Familiar Tasks: Struggling with everyday routines, such as following a recipe or managing finances.

·       Language Problems: Difficulty finding words or maintaining conversations.

·       Personality or Mood Changes: Increased irritability, depression, or withdrawal from social activities.

If you or a loved one are noticing persistent memory concerns, early detection can make a difference. For more information or to schedule a consultation, please contact our office at 732-988-3441.

Gianna Scimemi, M.A.
Psychometrician & Doctoral Student

As clinical neuropsychologists, we are often asked to identify the cause of thinking changes. Many conditions can cause thinking and memory problems, ranging from neurodegenerative diseases like Alzheimer’s to vascular disorders that reduce blood flow to the brain. Understanding the underlying process is crucial, as different conditions require different approaches to treatment and management. Some disorders present with clear patterns, while others are rare and often overlooked.

Recently, I evaluated a patient whose cognitive profile and symptom timeline were consistent with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), a rare genetic disease affecting small blood vessels in the brain. This condition leads to strokes, cognitive decline, and migraines. It usually starts between the ages of 30 and 60. The disease can also cause mood and behavior changes, such as depression, anxiety, irritability, and difficulty controlling emotions. Some people may act impulsively or, in rare cases, experience psychotic symptoms. These issues tend to get worse over time (months to years), making it harder to manage emotions and social interactions. Specifically, my patient reported migraines, impaired gait, apathy, and incongruent affect to mood, common early indicators of CADASIL.

My patient’s cognitive pattern of findings was consistent with a broad range of deficits in the form of attention-concentration, information processing, cognitive flexibility, multitasking, verbal reasoning, language, visuospatial/constructional reasoning, memory, and daily efficiency problems.

Complex neuropsychological examination programs were applied to the patient’s test results further supported a CADASIL diagnosis, revealing correlations linked to small vessel disease affecting deeper brain structures.

These findings, along with the timeline and progression of her decline, required my recommendations to follow up with neurology for genetic testing, skin biopsy, neuroimaging, and blood-based biomarkers for further evaluation.

This case makes our role in the diagnostic process even more critical, as early identification can help guide appropriate medical interventions, genetic counseling, and patient education to slow progression and improve quality of life.

Early detection is crucial in conditions like CADASIL. If you or a loved one are experiencing unexplained cognitive or neurological symptoms, a comprehensive neuropsychological examination can provide valuable information. Contact our office to learn more about next steps.

_____________________________
Zachary T. DiPasquale, Psy.D.
NJ Temporary Permit # 243-059
Neuropsychology Post-Doctoral Fellow

In our fourth and final blog post on the menopause transition (MT), we focus on the emotional well-being challenges – specifically, depression, anxiety, and low stress tolerance – that can show up during this time period. An estimated 4 of 10 women report mood symptoms such as tearfulness, low self-worth, feeling hopeless or numb, losing interest in formerly pleasurable activities, worry, and irritability. A changing hormonal landscape means unpredictable cycles –  there’s no clear-cut “PMS days” and many women struggle to know whether or not depression, anxiety, or stress symptoms are connected to their hormones. In modern day medicine and psychology, we generally believe that there are three contributing factors of any emergence of symptoms or conditions: (1) biology/genetics; (2) social/environmental; and (3) psychological/personality. With that said, let’s breakdown how menopause and emotions intersect:

(1)   Biological factors: Hormones are messengers. Some hormones steer the course of reproduction, some direct the physical growth of the body and cells, and some produce neurotransmitters which influence how you think and feel. Estrogen (a hormone) regulates serotonin (a neurotransmitter). As estrogen changes, serotonin receptors become less responsive and effective. Brain regions that are serotonin dominant (like the hippocampus, the brain’s memory center) will struggle the function the same way they did when estrogen was at it’s peak.

(2)   Social factors: These decades of life (40-50s) are like a stress squeeze point – aging and/or dying parents, raising and launching kids, trying to maximize career earnings and promotions, dealing with new age-related health issues or crises (like increasing cancer rates, chronic pain), potential of divorce or marriage difficulties, etc. All contribute to high baseline levels of stress, sleep disruption, more emotional eating, and sedentary lifestyles that are not conducive to emotional well-being.

(3)   Psychological factors: Having a history of depression, premenstrual dysphoria disorder (PMDD), trauma, poor coping mechanisms, fixed mindset, and low stress tolerance are risk factors for a poor adjustment to menopause. “The window of vulnerability” model suggests that certain women are predisposed to hormonally-driven mood symptoms in connection with “sensitive” periods of fluctuations, notably the onset of menarche (puberty), in the perinatal and postnatal phases, and menopause transition.

With this information in mind, what are some tips to navigating emotional changes that can accompany menopause?

(1)   Be proactive versus reactive. Attend doctors appointments, start asking for hormone bloodwork panels in your late 30s-early 40s to identify baseline levels and changes. Let your doctor know if you had depression or anxiety that started around puberty and/or prenatal or postpartum depression/anxiety/OCD/etc. so that it can be monitored as you enter into perimenopause and menopause.

(2)   Get serious about healthy lifestyle routines. Sleep is paramount in steadying emotions and optimizing stress tolerance. Taking control of controllable factors (like, how much time do I spend on my phone before bed? Can I start lifting weights instead of just doing cardio only?) related to sleep hygiene, eating habits, physical activity, and quality of relationships can offset hormonally-driven emotional changes.

(3)   Alter the mindset towards menopause. We have other messengers inside our brains besides hormones. Our own narrative (aka, “self-talk”) about menopause and beyond influences health behavior, mood, and biology. For instance, scenario A: “I’m a captain of a ship sailing in stormy waters but I know the waters will calm and I know the route I have to take to get there quicker” versus scenario B: “I’m a passenger of a boat sailing into a storm and I can’t control the weather so it’s just going to be what it is and I hope I survive.” Those statements hit differently, right? Choose your mindset and the behaviors follow.

If you are concerned that the menopause transition is harming your emotional well-being and would like strategies to manage symptoms of depression, anxiety, and stress with support, contact this office at 732-988-3441 to schedule a consultation with a clinical health psychologist.

Lauren Gashlin, PsyD

Clinical Health Psychologist

A subset of traumatic brain injury (TBI) cases involves “mild” injuries which are often termed mild traumatic brain injury (MTBI) or concussion.  As is well documented in medicolegal literature, many of these cases are litigated.  The forensic neuropsychological evaluation, often referred to as an independent neuropsychological evaluation (e.g., INE) are valuable in cases of MTBI.

Traumatic brain injury (TBI) constitutes a major medical problem despite its high visibility and changes in state law (e.g., seat belts, speed limits, blood alcohol levels).  Millions of individuals sustain TBI’s annually throughout the United States.  Fortunately, the vast majority of these individuals are considered “mild” and symptoms often improve spontaneously within the first few weeks or months post-injury.  Despite this, many individuals who were diagnosed with a MTBI or possible misdiagnosed find themselves involved in some form of litigation (e.g., personal injury).  These individuals might be “labeled” neurotic or even as a malingerer or symptom exaggerator.  The latter concerns (e.g., malingering, symptoms exaggeration) and patient effort (e.g., response bias) must always be considered and be part of a formal evaluation especially in litigated cases.  It is in these cases where a well-trained and competent neuropsychologist might prove beneficial in rendering an expert opinion regarding the consequences of such injuries and subsequent claims.

An individual’s ability to be successful in activities of daily living (ADL), is vitally important during personal injury litigation.  Plaintiff and defense attorneys undoubtedly are interested in determining how an individual is functioning post-injury.  Plaintiff and defense attorneys have different roles and view assessment outcomes according to their client representation (e.g., maximize deficits; minimize deficits).  The neuropsychologist will assist the attorney, referral sources, and the trier of fact in answering specific questions related to an individual’s pre and post trauma status (e.g., level of functioning).  Neuropsychological test results provide information to assist in childhood, adult, and geriatric neurocognitive and behavioral conditions, particularly when neurologic, radiologic, and laboratory data are inconclusive (e.g., MTBI, post-concussive syndrome).  A neuropsychological evaluation also establishes an objective baseline of function, which can be later compared with re-assessment results, that is invaluable in determining the course of cerebral dysfunction.  The contribution of a patient’s personality and mood to his or her symptoms is also estimated via formal assessment.  Neuropsychological test data also help predict a patient’s short and long-term prognosis which is important during litigation.

A comprehensive neuropsychological evaluation (INE) is not limited to formal testing.  The neuropsychologist also interviews the patient and others (e.g., spouse, family member, friend) to obtain collateral information, assess the patient’s behavior throughout the interview and testing phases, document all findings, and if the test results are deemed valid, render an opinion with a reasonable degreed of neuropsychological certainty.  An INE does not afford the usual degree of confidentiality inherent in clinical evaluations and a doctor-patient relationship is not established.

Overall, neuropsychological evaluation (e.g., INE) of individuals with suspected or documented MTBI is of the utmost important in both clinical and forensic settings.  Moreover, in legal proceedings, the neuropsychologist as expert will assist both plaintiff and defense attorneys, as well as the trier of fact, in understanding neuropsychological evidence.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
|Licensed Psychologist #35S100252900

Somatic Symptom Disorder (SSD) is diagnosed when an individual experiences significant level of distress in response to physical symptoms and struggles coping. The symptoms may or may not be explained by a medical condition, or represent normal bodily sensations such as pain or discomfort. The reaction is often extreme and out of proportion to the symptoms, affecting person’s daily functioning. SSD occurs in about 5-7% of the general adult population. In addition, it often co-occurs with other disorders such as depression and anxiety.

Symptoms of SSD

·        Excessive, persistent, and disproportionate thoughts about the seriousness of one’s symptoms.

·        Persistently high level of anxiety about health and symptoms.

·        Excessive time and energy devoted to the symptoms/health concerns.

·        Avoidance behaviors due to irrational beliefs about seriousness of the condition or potential to cause harm.

Possible causes of SSD

·        Genetic or biological factors (e.g., high pain sensitivity)

·        Personality characteristics (e.g., negativity)

·        Reduced awareness/difficulty processing emotions

·        Trauma

·        Learned behavior

Somatic Symptom Disorder (SSD) is treated by properly managing any medical condition (if present) as well as psychological symptoms. Here at NRS|LS, we offer comprehensive psychological assessment and treatment. If you or someone you know struggles with symptoms of SSD, please contact our office for a consultation.

Basia Andrejko-Gworek, Ph.D
Clinical Psychologist
License # 35SI00767400