Tbi: Mental Illness Or Not?

Traumatic brain injuries (TBIs) are a common occurrence, with at least 1.4 million cases in the US each year. TBIs can have a significant impact on an individual's mental health, with psychiatric disorders frequently reported following such injuries. Research has indicated that psychiatric disorders are common following TBIs, with depression, anxiety, post-traumatic stress disorder (PTSD), and changes in mood and personality being the most prevalent. The risk of developing these disorders is higher in individuals with a history of mental illness or substance abuse, and the presence of these disorders can have a detrimental effect on an individual's quality of life and social functioning. Treatment for mental health issues following a TBI typically involves a combination of medication, neurorehabilitation, psychotherapy, and lifestyle changes.

Traumatic brain injury and depression

Traumatic brain injury (TBI) can lead to a wide range of physical and cognitive symptoms, including confusion, mood changes, memory loss, and difficulty with reasoning or learning. It is also associated with an increased risk of developing depression. Research suggests that the risk of depression following a TBI may be two to five times higher than in the general population.

Depression is a common mental health issue for people with TBI, with half of all survivors experiencing it in the first year following their injury. It can also develop later as the person starts to understand the full impact of their injury, leading to feelings of hopelessness and altered self-esteem and identity.

The treatment for depression in people with TBI is similar to that for people without TBI and may include antidepressant medication and behavioural therapy. However, it is important that treatment for depression is integrated into the overall TBI treatment plan to ensure successful long-term recovery.

• Try to talk to family and friends about how you're feeling. If you find this difficult, try writing a letter or finding other ways to communicate.
• Avoid becoming socially isolated. Spend time socialising with people face-to-face, even if it's just meeting a friend at a quiet location. Consider joining a local support or activity group, such as a Headway group.
• Engage in activities that you enjoy, such as listening to music, creating art, or reading. Research indicates that these activities can help with coping with depression.
• Educate yourself on the effects of brain injury. Understanding your injury may be the first step towards accepting it.
• Try to exercise for a few minutes every day, even if you experience fatigue or have limited mobility. Exercise is a proven method for improving low mood.
• Seek support from services such as the Headway helpline, local Headway groups, or depression-specific support groups.
• Identify and address specific issues in your life that may be causing or contributing to your depression, such as financial or relationship problems.
• Speak to your doctor about your general health, including any potential hormonal imbalances that can arise after brain injury.
• Consider putting together a 'soothe box' containing items that may make you feel better when you're depressed, such as photos, letters, perfumes, or soft fabrics.
• Explore wellbeing techniques such as mindfulness, yoga, meditation, or other relaxation methods. Although research in this area is limited, brain injury survivors often report benefiting from these practices.
• Maintain a healthy lifestyle, including a healthy diet, plenty of water, no alcohol, and a good night's sleep.

If you are experiencing severe depression or having suicidal thoughts, it is vital that you seek help. Talk to your family or friends, or contact a helpline such as the Headway helpline or Samaritans. If you are having recurring thoughts of suicide, contact NHS 111 or make an emergency appointment with your GP.

Traumatic brain injury and anxiety

Traumatic brain injuries (TBIs) can cause a lot of changes in a person's life, and one of the most common effects is anxiety. In fact, over 80% of patients at a post-concussion clinic in Provo, Utah reported at least one emotional symptom, with anxiety and depression being the most common.

What Post-Concussion Anxiety Feels Like

Post-concussion anxiety can manifest in many ways, including:

• Feeling like you can't relax
• Feeling like you can't stop worrying
• Worrying about worrying
• Constantly imagining how something can go wrong
• Difficulty falling asleep
• Feeling uncomfortable and being unable to fix it
• Feeling tense, such as tight shoulders or stomach knots

Some patients also experience unprompted panic, a racing heartbeat, dizziness, or fear about something they can't explain.

Our bodies have a threat response system with three prongs: fear, anxiety, and anger. Concussions can prompt our anxiety system to over-activate, sometimes leading to generalized anxiety disorder. This can be caused by:

• A perceived increase in potential threats
• Persistent and severe symptoms that don't go away with time
• The anxiety-provoking symptoms themselves

Getting Help for Post-Concussion Anxiety

If you're experiencing anxiety after a head injury, you can get help. It's important to treat the post-concussion symptoms first, and then follow up with additional psychotherapy as needed. At clinics like Cognitive FX, patients go through intense therapy designed to help their brains relearn efficient and healthy functioning.

Evaluating the Need for Anxiety Medication

Most anxiety medication falls under two categories: SSRIs and beta-blockers. SSRIs are only impactful for roughly 30% of people, and beta-blockers are only intended for short-term use. Whether or not you take anxiety medication is a personal choice, weighing how much anxiety is affecting your ability to function with the possible consequences of taking medication.

Traumatic brain injury and post-traumatic stress disorder

Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are often comorbid, as brain injuries are frequently sustained in traumatic experiences. PTSD involves emotional, behavioural, and cognitive symptoms that arise following exposure to significant threat to life, serious physical injury, or sexual violence. TBI involves damage to the brain from an external force.

The scientific community once believed that alterations of consciousness associated with TBI precluded the formation of a trauma memory, making it improbable for PTSD to develop following TBI. However, experts now recognise that PTSD may develop following TBI due to several factors: implicit (unconscious) encoding of affective and sensory experiences associated with the traumatic event, conscious encoding of some aspects of the event, reconstruction of the trauma memory from secondary sources, and memory of circumstances surrounding the event that may also be psychologically traumatic. When psychological trauma is ongoing, PTSD may develop in response to the broader series of events, even if the specific event leading to TBI is not remembered.

The overlap in symptoms between TBI and PTSD can make etiological attributions challenging. Symptoms that are more specific to PTSD include re-experiencing symptoms, shame, and guilt. Headache, sensitivity to light and sound, and dizziness are more specific to TBI. Symptoms that are common to both include depressed mood, anxiety, insomnia, irritability, difficulty concentrating, fatigue, hyperarousal, and avoidance.

TBI has emerged as a clear and important risk factor for the development of PTSD, although the reasons for this association are not fully understood. PTSD may also be an important mediator of the negative sequelae of TBI.

Traumatic brain injury and bipolar disorder

Traumatic brain injury (TBI) is a worldwide public health problem. TBI is a silent epidemic because of the limited knowledge about the issue and its symptoms, such as memory and cognitive problems, which may not be immediately evident. TBI can be caused by a penetrating or closed brain injury. The latter occurs when there is no brain tissue exposure. TBI can lead to psychiatric disorders, including bipolar disorder. Mania due to TBI should be suspected when there is an atypical age for the beginning of the symptoms and a lack of personal or family history of psychiatric disorders. Mania due to TBI may present more aggression, more irritable moods, and less euphoria. Olanzapine was effective and well tolerated for the treatment of mania following TBI.

Traumatic brain injury and obsessive-compulsive disorder

Traumatic brain injury (TBI) is a significant cause of psychiatric morbidity in victims. Recognized neuropsychiatric sequelae of TBI include anxiety, obsessions, compulsions, and obsessive-compulsive disorder (OCD). OCD is characterised by a spectrum of clinical symptoms, including unwanted thoughts and intense compulsions to act and repeat behaviours in a ritualistic manner.

Current studies suggest that the emergence of OCD and OCD symptoms after TBI is influenced by various factors, such as underlying sub-clinical diathesis, brain injury lesion sites, environmental stressors, and the rehabilitation process. The development of OCD after TBI is rare, but obsessive-compulsive symptoms are not uncommon.

In a study by Grados et al. (2008), 80 children and adolescents with severe TBI were interviewed, and it was found that 29.2% of them developed obsessions and compulsions (OCS) within a year of their injury. The most common manifestations of OCS were worries about disease and cleanliness, along with excessive cleaning and ordering behaviours. The study also found that anxiety disorders, mania, dysthymia, depressive symptoms, and post-traumatic stress disorder were significantly associated with new-onset OCS. Interestingly, injury severity was not linked to new-onset OCS, but greater psychosocial adversity and being female were associated with an increased risk of developing OCS.

Neuroimaging studies have also provided valuable insights into the connection between TBI and OCD. Functional brain imaging has shown altered function in the neurocircuitry between the orbitofrontal cortex, caudate, and thalamus in OCD patients. Specifically, increased activity has been observed in the frontal lobes, basal ganglia, and cingulum. These areas are of particular interest in anxiety disorder research. Additionally, dysfunction in the prefrontal cortico-striatal-thalamic-cortical (CSTC) pathways has been consistently associated with obsessive thoughts and compulsive urges.

In summary, while the development of OCD after TBI is rare, obsessive-compulsive symptoms are not uncommon and can significantly impact an individual's life. Further studies are required to enhance our understanding of the underlying mechanisms and to develop effective therapeutic interventions for individuals experiencing OCD or obsessive-compulsive symptoms following TBI.

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