brain injury and mental illness: symptom overlap
TRANSCRIPT
Amy Daniel, RN, MSN, CNOR Support Group Facilitator
Phone: [email protected]
Brain Injury and Mental Illness : Symptom Overlap
What is a Traumatic Brain Injury
• TBI is a Worldwide Health Problem “Silent Epidemic” (limited knowledge about the issue and its symptoms. • Greater than 1.4million TBI’s occur each year with 50,000 fatalities and
the remaining treated and released with varying levels of disability. • In excess of 5.3 million people live suffering long term disabilities from
TBI.• Acquired TBI is caused by falls, traumas, traffic accidents, violence,
drownings, overdose, unsuccessful suicide attempts, strokes etc.
Symptom Overlap:TBI Disrupts Thought Processes
• Attention problems (concentration, tracking, filtering)• Memory impairment• Conceptual disorganization• Altered causal or logical reasoning• Executive dysfunction (e.g., planning, organizing, prioritizing,• staying on-task/ focus and attention
Symptom Overlap: TBI Can Lead toPersonality and Affective Changes
• Mood changes, including depression, anger, mania, or decreased control of emotions/behavior• Affective blunting or lability• Paranoia, hallucinations• Unusual beliefs or delusions/ misunderstanding of social cues• Psychiatric Disorder rates for incidence and prevalence is higher
post TBI than in the general population. (Schwarzbold et al.)
Psychiatric Problems IncreaseRisk of Brain Injury/ Reinjury
• Vassalo et al. (2007) studied psychiatric risk factors for ABI in a sample of 3766 non referred community dwelling US veterans.• Depressed persons were at 2 ½ times greater risk of brain
injury.• Persons with anxiety and conduct disorders were at 60%
greater risk of TBI.
Violence, Abuse and Neglect after TBI(Reichard et al, 2007)
• If this small (N=9) qualitative study is accurate, this is a significant problem• BI survivors vulnerable to violence and neglect for number of
reasons• Reports of abuse by persons with brain injury often discounted• Participants suggested strategies for prevention: support systems,
anger management skills, prevention of drug and alcohol abuse, public education regarding TBI.
Lack of Mental Health intervention with TBI leads to a Big Problem, with a Broad
Impact• Increased Medicaid expenditures for persons with both BI and
mental illness (Wei et al. 2005).• More than 40% of homeless hospital admissions with
schizophrenia-like symptoms had history of TBI (Silver &McKinnon, 1993).• Of 15 death row inmates, all had history of severe brain injury and
9 had recurrent psychoses preceding incarceration (Lewis et al. 1986).
Treatment Models andApproaches
Treatment Models: The BIG Band-Aid with HOLES
• Brain Injury: Rehabilitation through skills re building and compensatory strategies largely do not incorporate Mental illness treatment. • Crisis (Band-aid) is early in treatment only with pediatric and
adult TBI survivors. • Mental Illness: Habilitation, skills building long term are
difficult to access• Alliance (It takes a village…) (100%Access)
Treatment Strategies
• Physical crisis management skills in the community/ law enforcement TBI education• Support groups (BRIDGESNKY) • Support the natural supports/ caregiver mental health services. • An ounce of follow-up is worth a pound of crisis intervention. • Psychiatric consultation is a key component
Importance of Psychiatric/Mental Health Intervention
• Understanding of brain injury critical: Diagnosis and determination of cause guides medical treatment and should include psychiatric treatment. • Potential causes of mental health sequela with TBI:• Posttraumatic seizure/ Migraines• Untreated Depression/ Mania. • Ongoing or past substance abuse.• Schizophrenia-like disorder.
• Determine Medication management most effective in context of psychotherapeutic support with consideration of TBI.
What Is Needed?
• We need specialists with skills in several areas: TBI, mental illness, substance abuse.• It takes a village: structure, supports and ongoing follow-up.• A village with resources does a better job than one without.• Political advocacy as part of the process at Local, State and Federal
level.• A coalition of brain injury, substance abuse, and mental health
advocates speaking in one voice.
Thank you for your interest in helping Brain Injury Survivors! Like mine.
Friday, March 31, 2017
11th Annual NKY TBI ConferenceApplicable Strategies for TBI RecoveryReceptions Conference Center, Erlanger
KY
Contact: Julie [email protected]
text/phone: (859) 802-4077
Visit: bridgesnky.org