Mood and anxiety disorders following Traumatic Brain Injury

Introduction

The common causes of traumatic brain injuries include accidents, physical and emotional assaults, high contact sports among other related factors. About 1.5 million people in the United States sustain injuries rated as traumatic brain injuries annually (Ricardo, 2008). Out of these, about 80, 000 up to 90,000 of these patients experience long-term disability conditions. Owing to these rising concerns on traumatic brain injuries, there has been a renewed interest in studies examining various aspects of these conditions as well as the suitable intervention mechanisms for different affected individuals. Fann et al. (2004) found out that mood and anxiety disorders are the most frequent psychiatric conditions commonly experienced by patients diagnosed with TBIs. Using structured interviews and the DSM-IV criteria to analyze the Axis I psychopathology among 100 patients after 8 years of diagnosis with TBI, Whelan-Goodinson et al. (2009) found that depression constituted 61% of the patients’ conditions. Mood disorders constituted 42% among patients diagnosed with depression in a study of 303 persons based on DSM-IV criteria (Schwarzbold, 2008). This rate is even higher among depressed patients who had experienced traumatic brain injuries in the past compared to the other group of patients who have suffered mere orthopedic disorders (Whelan-Goodinson, 2009). Some studies have also revealed effects on the CNS following TBI incurrence, amnesia, unconsciousness (Mayou, Black & Brayant, 2000), elevated heart resting rates (Brayant, et al., 2004), etc.

Diagnosis discussion

A lot of the diagnostic criteria used to identify, classify and rate mood and anxiety disorders manifested among patients diagnosed with TBI also used in psychiatric diagnoses for various conditions. The DSM-IV and V have been utilized in various studies to identify and categorize the levels of mood and anxiety disorders occurring in post-traumatic brain injuries (Fann et al. 2004; Schwarzbold, 2008; Whelan-Goodinson et al. (2009). Whelan-Goodinson et al. (2009) used DSM-IV criteria in combination with structured interviews to study the various psychiatric disorders affecting 100 patients diagnosed with TBI. The effectiveness of the study was pegged on the fact that the study was carried out eight years after the patients had sustained the injuries. The structured interviews provided supplementary insights into the levels of anxiety and mood disorders in the affected persons by probing more insights not included in the DSM-IV chart.

The improvement of DSM-IV chart to DSM-V chart has revived the effectiveness of this chart in examining the occurrences of psychiatric conditions among TBI patients. Mayou et al. (2000) used the modified DSM-V chart to rate the levels of unconsciousness and occurrence of amnesia as a basis for testing the occurrence of PTSD among traumatized patients due to TBI incurrence. Together, these studies are often complemented by several other assessment criteria developed by scientists to examine the levels of disorders incurred in the affected patients. The accuracy of each criterion/ method depends on various factors including the assessor’s level of expertise amidst a host of other related factors.

Intervention mechanisms

Although studies present different intervention methods depending on the patients’ specific conditions and characteristics at the time of the interventions/ treatment, majority of the literature recommend intervention mechanisms such as citalopram and sertraline as the most preferred rehabilitation techniques for patients with mood and anxiety disorders following TBI (Turnes-Stokes & MacWalter, 2005). These methodologies help to lower the profiles of the associated side effects. Moreover, drugs such as fluoxetine, paroxetine, methylphenidate, milnacipran and desipramine among other have been recommended in the different literature for patients diagnosed with mood and anxiety disorders following traumatic brain injuries (Yudofsky et al.1986). Used together, these studies have posted positive results under different circumstances depending on the state of the patients and the response conditions. In addition to these, electroconvulsive therapies administered to patients with mood and anxiety disorders following TBI have also yielded positive results in various experimental studies (Yudofsky et al..1986). However, the method has also been associated with transitory worsening of the patients’ cognitive deficits caused as a result of the related side effects to mood and anxiety disorders.

Summary and follow-up

Summarily, mood and anxiety disorders are rising conditions that affect many people in the world today as a result of the increasing exposure conditions. Proper diagnostic tools such as   DSM-IV and DSM-V alongside other related psychiatric approaches have been recommended for use to detect, categories and examining the conditions for various patients. Patients’ follow-up is an essential point of reference, especially in psychiatric conditions. Psychiatric interventions and drugs therapies are among the key intervention mechanisms. Psychiatric infections may occur rapidly, but the treatment processes gain significant positive results gradually. As such follow-ups are critically important for ensuring recovery and compliance with the drugs administered. Some patients find it hard to cope with the highly demanding treatment conditions further fuelling their psychiatric conditions. For mood and anxiety disorders, follow-up activities help in alleviating the perceptions and mood changes commonly experienced in such persons and thus reduce their anxieties (Yudofsky et al..1986).

 

References

Fann, J.R., et al. (2004). Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Arch Gen Psychiatry, 61:53-61.

Mayou, R.A., Black, J., Bryant, B. (2000). Unconsciousness, amnesia and psychiatric symptoms following road traffic accident injury. Br J Psychiatry, 177, 540-545.

Ricardo, E.J. (2008). Mood and Anxiety Disorders Following Traumatic Brain Injury. A New Nerve Center for Neurology. Retrieved June 29, 2016, from <http://www.psychiatrictimes.com/articles/mood-and-anxiety-disorders-following-traumatic-brain-injury>.

Schwarzbold, M., (2008). Psychiatric disorders and traumatic brain injury. Neuropsychiatric Disease and Treatment, 4(4): 797–816.

Tuner-Stokes, L., & MacWalter, R., (2005). Use of antidepressant medication following acquired brain injury: concise guidance. Clin Med, 5,268-74.

Whelan-Goodinson, R., Ponsford, J., Johnston, L., & Grant, F. (2009). Psychiatric disorders following traumatic brain injury: their nature and frequency. Journal Head Trauma Rehabilitation, 24(5):324-32. Doi: 10.1097/HTR.0b013e3181a712aa.

Yudofsky, S.C., et al., (1986). The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry, 143, 35-9.

 

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