Neuropsychiatric Symptoms and TBI

Question 1

Factors influencing neuropsych symptoms

Answer 1

age, gender, injury location, premorbid symptoms, injury severity

others: marital discord, poor relationships, work problems, financial instability

Question 2

dual diagnosis

Answer 2

the relationship of a set of symptoms, including behaviors, which are or resemble symptoms of a known psychiatric disorder

• ex: TBI and symptoms of bipolar

Question 3

dual diagnosis and rehab

Answer 3

These problems can impact outcomes both physically and neuro mental health

Areas Requiring Special Attention:
Community Reintegration
Peer Relationships
Caregiver Burden
Loss of Independence
Economic Stress

Question 4

dual diagnosis and long term outcomes

Answer 4

For patients with TBI: anxiety and depression were linked to poorer outcomes later in life

Those with severe injuries had lower rates of depression, suggesting self-awareness plays a role in rate of depression

Important Question: Are depression and anxiety related to biochemical changes of the injury or the result of the person’s attempt at coping with impairments?

Question 5

most common dual diagnosis

Answer 5

Axis 1: depression with TBI
Axis 2: avoidant, paranoid, schizoid

require time and attention to treat along with TBI

Question 6

depression and area of injury

Answer 6

links between:
frontal lobe 
left prefrontal gray matter reduction 
lateral and medial frontal lobe lesions 
amygdala and hippocampus lesions
basal ganglia lesions

Question 7

Right vs. left hemisphere injury and dual dx

Answer 7

left hemisphere = tends to co occur with depression alone

right hemisphere = tends to co occur with depression and anxiety

Question 8

mental health disorder rates for TBI

Answer 8

he rates for depression, panic disorder, phobic disorder, and generalized anxiety disorder were far greater along with an increase in suicide attempts, although frequency varied

TBI is associated with changes in behavior and personality

Question 9

major depressive episode

Answer 9

Definition: At least 2 weeks in which the individual experiences loss of interest or depressed mood accompanied by at least four additional symptoms 
Change in appetite
Weight gain
Decreased energy
Feelings of worthlessness
Suicidal ideation

risk for developing: Socioeconomic status
Premorbid psychiatric pathology

Question 10

manic episode

Answer 10

Identified by a period of at least 1 week where the individual has a noticeably elevated, expansive, or irritable mood with at least 3 additional symptoms (4 if the mood is only irritable):

• Extremely amplified self-esteem
• Decreased desire for sleep
• Grandiose ideas
• Distractibility
• Risk activities

it can be hard to determine if it is related to TBI
Those relevant to TBI include increased aggression, irritability, and activation, and decreased euphoria and sleep

Question 11

bipolar affective disorder

Answer 11

recognized as a mood disorder further classified as bipolar I, bipolar II, cyclothymia, and bipolar disorder not otherwise specified (NOS)

Question 12

bipolar 1

Answer 12

1 or more manic episodes

Question 13

bipolar 2

Answer 13

one or more depressive episode followed by one or more hypomanic episode.

Question 14

cyclothymia

Answer 14

chronic fluctuating mood disturbance including both depressive and hypomanic states

Question 15

generalized anxiety disorder

Answer 15

Most often described as feelings of fear or worry

May also include fatigue, irritability, muscle tension, restlessness, decreased concentration, and changes in sleep

Those with TBI may worry about: 
Making mistakes
Finances
Loss of control
Difficulty problem solving
Becoming overwhelmed
Fear of falling or pain
Memory deficits

Question 16

panic attack

Answer 16

happens to ppl with generalized anxiety d/o

anxiety occurs very suddenly and intensely
Include intense fear + pounding heart, sweating, trembling, shortness of breath, feeling of choking, chest pain, abdominal symptoms, dizziness, fear of losing control or dying, numbness or tingling, chills, or hot flashes

Premorbid tendency to worry leads to increased risk for developing GAD post TBI

Important Fact: Those with anxiety or depression perceive their illness as far more severe regardless of injury severity/deficits

Question 17

Obsessive-Compulsive Disorder (OCD)

Answer 17

characterized by repetitive, ritualistic behavior that is so severe that it becomes time consuming

OCD does not appear to be common post-TBI

OCD, if not diagnosed and treated, can significantly impair a patient’s ability to rehabilitate and reintegrate

Question 18

panic disorder

Answer 18

Repeated panic attacks followed by worry about future attacks or changes in behavior related to the panic attack 
Characterized by intense fear accompanied by at least four somatic symptoms including 
Sweating
Palpitations
Trembling/shaking 
Nausea
Chest pain
Dizziness
Chills
Hot flashes

Question 19

PTSD

Answer 19

A group of symptoms following a traumatic event that may include re-experiencing the traumatic event, persistent avoidance of stimuli, increased arousal, anger issues, irritability, and flashbacks

Reduced awareness/amnesia following the traumatic event may decrease the likelihood for developing PTSD

PTSD can occur following TBI

Question 20

schizophrenia and TBI

Answer 20

Definition: A disorder lasting for at least 6 months characterized by a minimum of a 1-month phase of symptoms that include delusions, hallucinations, incoherent speech, catatonia, or avolition

Studies suggest a correlation between TBI and Schizophrenia ; nd increased chance to develop post TBI

Schizophrenia and TBI can lead to:
Problems with social relationships
Independence
Cognitive, behavioral, and psychological problems

Will severely compromise rehab efforts and create additional stressors that further complicate the reintegration process

Question 21

personality disorder (organic)

Answer 21

Organic Personality Disorder is the traditional diagnosis for individuals who develop personality disorder following TBI, exhibiting a change from the person’s pre-injury personalities

Changes that fall into the category of personality disorder: 
Apathy
Affective lability
Uncontrolled emotions
Aggression  

Most frequently reported personality disorders: avoidant; paranoid; and schizoid

Loss of recognition of inappropriate behavior can be an additional obstacle to modifying/improving behavior lead to greater hardships within rehabilitation, daily living, relationships, and independence

Question 22

frontal lobe syndrome

Answer 22

presents symptoms of other psychiatric disorders including depression, psychosis, mood disorders, and various other conditions

TBI can often increase risk for development of depression or anxiety related to damage to the neural networks, leaving the brain unable to regulate emotions AND unable to recognize

Question 23

rehab for person with dual dx

Answer 23

Integration of mental health services as part of the rehab plan

Inclusion of specific strategies designed to address psychological issues in the skills-based approach

Lifelong rehab as increased psych needs as they gain more insight is likely