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Amy Daniel, RN, MSN, CNOR Support Group Facilitator
Phone: [email protected]
Brain Injury and Mental Illness : Symptom Overlap
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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.
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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
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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.)
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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.
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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.
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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).
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Treatment Models andApproaches
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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)
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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
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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.
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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.
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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