Neuropsychiatric Symptoms and TBI Flashcards
Factors influencing neuropsych symptoms
age, gender, injury location, premorbid symptoms, injury severity
others: marital discord, poor relationships, work problems, financial instability
dual diagnosis
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
dual diagnosis and rehab
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
dual diagnosis and long term outcomes
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?
most common dual diagnosis
Axis 1: depression with TBI
Axis 2: avoidant, paranoid, schizoid
require time and attention to treat along with TBI
depression and area of injury
links between: frontal lobe left prefrontal gray matter reduction lateral and medial frontal lobe lesions amygdala and hippocampus lesions basal ganglia lesions
Right vs. left hemisphere injury and dual dx
left hemisphere = tends to co occur with depression alone
right hemisphere = tends to co occur with depression and anxiety
mental health disorder rates for TBI
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
major depressive episode
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
manic episode
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
bipolar affective disorder
recognized as a mood disorder further classified as bipolar I, bipolar II, cyclothymia, and bipolar disorder not otherwise specified (NOS)
bipolar 1
1 or more manic episodes
bipolar 2
one or more depressive episode followed by one or more hypomanic episode.
cyclothymia
chronic fluctuating mood disturbance including both depressive and hypomanic states
generalized anxiety disorder
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
panic attack
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
Obsessive-Compulsive Disorder (OCD)
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
panic disorder
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
PTSD
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
schizophrenia and TBI
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
personality disorder (organic)
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
frontal lobe syndrome
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
rehab for person with dual dx
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
