Traumatic brain injury and mental illness
1. What is the relationship between traumatic brain injury and mental illness?
Traumatic brain injury (TBI) has long been known to be associated with changes in mood, personality, and behavior. The study found also contributed to the hypothesis that factors directly related to TBI might be responsible for these changes. However, much of this study was based on a dimensional assessment of symptoms and did not include an assessment of the presence or absence of psychiatric disorders. TBI is considered by some to be a risk factor for psychosis.
Establishing a causal relationship between TBI and psychiatric disorders is important to our understanding of the possible sequelae of TBI, and it will also help us better understand pathogenesis of these diseases. If it is shown that TBI causes mental illness, this should alert clinicians to observe or try to prevent these outcomes. Such a causal finding would also have a role in outcome-related litigation after TBI. Rather than discovering, as is sometimes the case, that an individual's difficulties after TBI are secondary to a mental disorder rather than TBI, it is more appropriate to treat the person's difficulties as secondary. after psychosis followed by TBI. It is important to clearly define the pathogenic role of TBI in the generation of psychiatric disorders from clinical, scientific and legal perspectives.
Arguing about causation is often difficult because putative pathogens can be difficult to assess or can be confused by the presence of other concomitant and potentially pathogenic factors. This is certainly the case with TBI, where insults to the brain can be difficult to detect and can be accompanied by a host of other factors such as pain, loss, and despair. Not too long ago, however, we also wondered about the causal relationship between newly discovered microscopic organisms grown in petri dishes and devastating infectious disease epidemics. This analogy is probably appropriate, since it is clear that TBI can cause injury to the brain at the microscopic level and has been described to occur with epidemic proportions.
2. What is traumatic brain injury?
3. How does severe traumatic brain injury affect mental health?
People who are in a vegetative state are not yet awake but may wake up at times. They may begin to open their eyes. This is also known as “Unresponsive Sobriety Syndrome”. They can respond quickly to sound, sight or touch and can even cry, laugh, or make facial expressions. But these reactions are reflexes and not within the control of the person. Like a coma, people in a vegetative state are unable to express emotions or engage in purposeful behaviors. People in a vegetative state are not aware of themselves or their surroundings. They cannot communicate or follow commands. The word macrobiotics does not mean that man is a "vegetable". It refers to "vegetative" or automatic functions still controlled by the brain, such as breathing, heart function, and digestion.
Everyone in a minimally conscious state begins to regain consciousness. They may have some awareness of themselves or their surroundings but not always. People in a minimally conscious state may occasionally engage in purposeful behaviors. For example, they may follow a simple command, look at people or objects around them, or stay focused on moving people or objects. They may reach for or try to use a common object, such as a hairbrush. They may show appropriate emotional responses or attempt to communicate through gestures or talking.
Emerging from a minimally conscious state refers to people who can communicate consistently or use at least two objects purposefully. During this stage, they can correctly answer questions simply by saying or gesturing with answers like "yes" and "no". They can also follow instructions and perform simple tasks.
When people regain consciousness, they may experience post-traumatic panic. This state of recovery may include a condition known as post-traumatic amnesia. People in this state are confused and have trouble forming new memories. They may not be able to walk or talk, recall memories, or recognize people they know. Often, people cannot remember where they are or what happened. They cannot remember everyday details or events. They cannot perform lengthy tasks. They may sleep a lot during the day but have trouble sleeping at night. They may be restless or agitated. People in this state can also do unsafe things, such as pulling on a breathing tube and feeding or trying to get up without assistance.
4. Neurological complications after traumatic brain injury
4.1. Depression, Nervousness
Depression, neurological disease after traumatic brain injury affects activities and cognition in life. TBI-related depression is characterized by a persistent, persistent feeling of sadness associated with other symptoms such as decreased muscle tone, lack of motivation, decreased self-care, altered sleep patterns, or appetite patterns , feelings of hopelessness or thoughts of suicide. These symptoms may last weeks to months (major depressive episode) or persist in a milder form for two years or more (arrhythmia).
Monoamine oxidase inhibitors (MAOIs) may also be considered in people with persistent depression. However, the need for dietary restriction can be challenging as adherence to a strict diet can be difficult for cognitively impaired TBI patients.
As in other cases of suicidal ideation, the most important factor in managing TBI-related suicidal behavior is maintaining safety. Consideration should be given to immediate hospitalization for patients with active suicidal ideation with intent or intent to die. Management of suicidal thoughts associated with psychosis after TBI should focus on the mental disorders themselves. Extra care is needed to maximize safety not only in the inpatient setting but also in the outpatient setting, ensuring that patients receive consistent outpatient care and have a support network strong.
4.3. Manic episodes after TBI
TBI mania is characterized by changes in mood, sleep and activation, which can manifest as irritability, euphoria, insomnia, agitation, aggression, impulsivity or even behavior vi violence. There is little literature on the pharmacological management of mania due to TBI.
Healthcare professionals recommend quetiapine as a first-line agent and risperidone as a second-line agent for acute mania, with valproate as a first agent and carbamazepine as a second agent for acute mania. maintenance. Although many psychiatrists may argue that lithium is the gold standard for the treatment of idiopathic bipolar disorder, we are concerned about CNS and motor side effects in individuals with TBI.
4.4. Anxiety disorders related to TBI
Medications commonly used to treat anxiety include sertraline, escitalopram, citalopram, and venlafaxine in doses similar to those used to treat TBI-related depression.
4.5. Sleep disorders
Sleep disturbances are common after TBI and may occur alone or as a symptom of a psychiatric disorder. Insomnia is the most common sleep disorder, occurring in about 50% of TBI patients, although other disorders such as insomnia, sleep apnea, and sleepwalking may also be present. Treatment of TBI sleep disorders varies according to the type of sleep disorder and associated comorbidities. A comprehensive medical evaluation including an overnight sleep study can help diagnose a sleep disorder. Maintaining sleep hygiene is always a top priority in controlling sleep disorders. When sleep disturbance accompanies psychosis, it is important to treat the underlying mental disorder.
When insomnia occurs in isolation, consider short-term use of a non-benzodiazepine hypnotic such as zolpidem. Other agents such as melatonin, amitriptyline, lorazepam, and zopiclone may also be considered. Benzodiazepines should be avoided secondary to the risk of addiction, motor and cognitive side effects, and paradoxical tantrums. In patients with TBI with excessive daytime somnolence, sleep apnea should first be ruled out. Modafinil (100-400 mg) or armodafinil (150-300 mg) may be considered in patients with persistent and unexplained daytime somnolence.
Vinmec Da Nang International General Hospital is one of the leading medical facilities for diagnosing and treating traumatic brain injuries today:
The hospital is fully equipped with modern medical machines and equipment, the most advanced imaging equipment to support diagnosis and treatment such as: G.E 3.0 MRI (MRI) scanner, Toshiba 640 slices CT SCAN, cerebral angiogram, MRA and CTA... for image quality Clear image, easy diagnosis and treatment of brain and spine diseases of both medical and surgical pathology (brain tumor, brain degeneration, white matter degeneration, congenital pathology of brain structure, trauma) traumatic brain injury, spinal cord injury, cerebrovascular disease: aneurysms and cerebrovascular malformations...) Being examined and treated by a team of qualified and experienced medical doctors. Patients are treated and recovered in modern wards, fully equipped with international standards, helping patients feel comfortable, providing maximum support for the treatment process.
Để đặt lịch khám tại viện, Quý khách vui lòng bấm số HOTLINE hoặc đặt lịch trực tiếp TẠI ĐÂY. Tải và đặt lịch khám tự động trên ứng dụng MyVinmec để được giảm ngay 20% phí khám bệnh lần đầu trên toàn hệ thống Vinmec (áp dụng từ 1/8 - 30/9/2022). Quý khách cũng có thể quản lý, theo dõi lịch và đặt hẹn tư vấn từ xa qua video với các bác sĩ Vinmec mọi lúc mọi nơi ngay trên ứng dụng.