Clinical Vignette:

Ms. A.C., a 17-year-old female student, was involved in competitive piano and ballet. Her grades were consistently outstanding. She had no personal or family history of psychiatric problems. She was out with friends on a Saturday night when she was involved in an accident. She fell off the back of a pickup truck and landed on her head. At the accident scene she was alert and oriented but felt dazed. In the emergency room, CT and neurological examinations were normal. She was observed for 2 hours and released. The patient's mother was told that her daughter was fine and that she should return to school and full activity on Monday. For the following few weeks, Ms. A.C. was unable to perform either piano or ballet at school, although she had no problem practicing at home. Her grades deteriorated. She became depressed and attempted suicide. Neuropsychological testing showed that the patient had a problem performing in the presence of interference (i.e., difficulty in maintaining a mental set). This is evidence of damage in the prefrontal region. The patient responded well to antidepressant therapy. Her frontal lobe deficit resolved spontaneously over time with continued nonpressured practice.