TBI and Mental Illness

I found an interesting post over at Lawyers Attorneys: Brain Injury and Schizophrenia: How to Deal

For victims of a traumatic brain injury (TBI) and their families, side effects such as bipolar disorder and memory loss are tragic, but well known and well understood. But in the last decades, scientists have begun to study another serious side effect of brain damage that may go undetected: schizophrenia.

What is Schizophrenia?

Schizophrenia (Greek for “shattered mind”) is a psychotic disorder that affects behavior, mood and thinking. The term was originally coined as “the schizophrenias” because of the wide variety of symptoms characterizing the condition. A misperception that all schizophrenics hear voices is actually untrue. It is a symptom in some suffering from schizophrenia but not all. Psychologists break symptoms of schizophrenia into three categories:

. Positive symptoms are behaviors that are not present in normal individuals. Other symptoms include hearing things, delusional though as well as sporadic thought.

. Negative symptoms are symptoms showing loss of normal abilities. They include loss of ability to show or feel emotion, lack of motivation and trouble with speaking.

. Neurocognitive defects are problems with brain function in areas such as memory, problem-solving, attention and social functioning.

Schizophrenia Related to Brain Injury in Patients

Scientists have established that psychiatric conditions such as bipolar and anxiety disorders are more common in patients who have suffered from traumatic brain injuries. Schizophrenia itself has been associated with individuals who have previously suffered brain damage regardless of family history. But it is only since the early 1990s that researchers have begun to explore in depth that connection between brain damage caused by traumatic brain injury and schizophrenia.

Schizophrenia and Brain Injury: Recent Studies

. Among the findings of those studies:

. TBI-associated schizophrenia is true schizophrenia, not another disorder with similar symptoms, according to a 2001 study by Columbia University. Schizophrenia and TBI are now being associated as hand-in-hand illnesses, one usually occurs in the victim of the other.

. Another study in the same year at the University of New South Wales in Australia discovered that TBI patients with schizophrenia-like psychosis had more widespread brain damage and cognitive impairment than TBI patients without psychosis. It also suggested that a family history of schizophrenia and the severity of the brain damage sustained during TBI increased the risk of schizophrenia.

. Scientists at the Hawaii State Hospital found in 2002 that it took an average of four to five years after a traumatic brain injury for psychosis to manifest, with most cases arriving within two years. Psychosis may be the result of trauma and blunt force to temporal and frontal lobes, for which researchers are attempting to determine.

While the complex nature of schizophrenia makes its cause unclear, as the last study suggests, there is evidence to believe that brain injury directly causes schizophrenia, by damaging the areas of the brain that control higher functions. There is also evidence that a traumatic brain injury may cause psychosis indirectly. Scientists believe that schizophrenia is caused by a combination of genetic susceptibility to the disease and an emotionally or physically traumatic experience that triggers this susceptibility. Researchers are finding that TBI and the trauma that can occur can actually trigger schizophrenia.

Many physicians know a traumatic brain injur may cause neurocognitive disorders such as trouble with speech, and psychiatric problems like bipolar disorder, but not all are aware of the growing evidence linking schizophrenia with brain damage. It is imperative that after a TBI accident, that a victim consult a psychiatrist to ensure that they return to normal behavior. In addition, brain injury patients and their families should consult an experienced brain injury attorney as they seek to recover costs for expenses such as lost wages, current medical costs and future medical care.

A couple of things came to mind when I read this:

  • Okay, so does it mean I’m going to lose my mind, because I sustained a TBI? Am I headed for a psychotic break?
  • If head-injured folks are given proper treatment, rest, nutrition, and time to heal after their injury, will that help prevent a later development of mental illness?
  • How is that these symptoms are ascribed to schizophrenia:

. Positive symptoms are behaviors that are not present in normal individuals. Other symptoms include hearing things, delusional though as well as sporadic thought.

. Negative symptoms are symptoms showing loss of normal abilities. They include loss of ability to show or feel emotion, lack of motivation and trouble with speaking.

. Neurocognitive defects are problems with brain function in areas such as memory, problem-solving, attention and social functioning.

I don’t know nearly enough about schizophrenia, but it seems to me that calling a neuro-physical condition a psychological one not only makes it difficult to properly diagnose, but also makes it difficult, even dangerous, to treat. Approaching an actual physical condition (or a neurological one) with a psychological approach might actually do more harm than good — convincing the specialist and the patient that there’s something wrong with them rather than something wrong with their bodily system.

Might this not actually make matters worse? I think psychotherapists and psychiatrists really need to think this through — familiarize themselves with TBI and its effects and realize what neuro-physical issues might truly come up along the way that mask themselves as psychological issues, and realize that they might be barking up the wrong tree.

Misdiagnosing TBI as schizophrenia or some other psychological disorder is dangerous, not only for the patient but also for the clinician, and it makes both parties chase the wrong ghosts. Not good for anyone involved.

(Note: I have more thoughts on this at this post – More thoughts on Brain Injury and Mental Illness)

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13 thoughts on “TBI and Mental Illness

  1. Hi,
    I just found your blog and wanted to thank you for writing it–I am currently coming to terms with my husband’s TBI/mental illness and I am trying to learn all I can. I’ll be bookmarking this one.

  2. hello, i’ve been reading some of your blogs-i still can’t believe that there are other people like me. i am only just coming to understand why i feel like i don’t fit in and am not understood. i can’t keep up with the pace of life. recently had seven hours of cognitive function tests and the results weren’t good, no one tells you what your meant to do once they are done treating you like a freak and guinea pig. found it hard to deal wit the reality of brain damage and the labelling of abnormal, can’t function like everyone else. it helps a whole lot to know that i am not alone. are there particular strategies that have helped you cope with life and continue to have aspirations. i’m not ready to give up on my dreams and goals-but i need to find ways of coping and helping myself-if you have any suggestions i would greatly appreciate it.

  3. Pingback: Depression - Page 3

  4. I read comments on TBI and it’s sad. I am a 4 1/2 year survivor of my latest TBI (there were 4 all together over 50 years). I was screwed by the medical community, the Board of Medical Examiners, and the Gov.’s Office in N Carolina. I lost everything. I have survived on my own; there was no help. All I can say is that you have to be your own best friend. If there is no one there for you, be there for yourself.

  5. More evidence of the desire to link tbi to a mental illness – and then drug people. Huge misunderstanding of tbi in psych community AND they can do the WORST thing possibly as a result.

  6. My father has this problem. How do they treat this condition? He was already diagnosed with Schizophrenia and put on medication. But after taking it for a while he now refuses to continue and thinks that he can prove to us all that his delusions are real. Can surgery correct this?

  7. That sounds like an issue for your/his doctor. Not knowing the details of the situation, I can’t speak to it. I haven’t the faintest idea if surgery can correct it. But if he is discontinuing medication, and if he may become a danger to himself and/or others, you’ll have to do something…

    Good luck with that.

    BB

  8. Psychosis and other altered thought symptoms resulting from TBI are NOT treated the same as those not resulting from TBI, and failing to understand this can be very detrimental to one suffering from TBI.

    Arcinegas at Univ of Colorado has published a paper on psychosis due to head injury in which the two conditions resembling schizophrenia are distinguished from one another.

    Also the info below explains why the CAUSE of the changed thought patterns should be determined (with brain injury definitely ruled out with neuropsychological and other testing) BEFORE drugs are used.

    I have seen recovery using homeopathics and the orthomolecular approach to my daughter’s serious symptoms following a head injury and a Halcion overdose by a dentist.

    I have seen very little improvement with benzos and antipsychotics, and witnesses SEVERE and life-threatening reactions to the latter, with a worsening in anxiety and paranoia.

    Whatever the cause, the least toxic approach to healing should be considered first and the Brain Bio Centre and the Orthomolecular Society info consulted by ALL MENTAL HEALTH facilities everywhere before they resort to any chemical treatments in non-emergency situations.

    “Patients who have had a TBI are more vulnerable to adverse effects of medication and are less likely to show evidence of benefit. Symptoms will often improve spontaneously. Furthermore, there may not be an indication for the symptom that the drug is being used for. It is prudent to continue drug treatment of behavioral, cognitive, and psychiatric symptoms after TBI only if there is good evidence that the patient is benefiting.”

    http://www.psychiatrictimes.com/trauma-and-violence/content/article/10168/1534138

    ” Many drugs given to brain injured persons have undesirable cognitive side effects and cause more harm than good. Certain antiseizure medications cause attention and memory problems, and choice of medication often does not reflect this awareness. Minor tranquilizers (such as Valium) which may calm anxious or tense persons without brain damage, may cause memory problems, poor judgment, and emotional control problems in head injured persons. Major tranquilizers, which organize psychotic thinking and calms agitated behavior in schizophrenics, can have the opposite effect after brain damage. The dampening of the neurotransmitter systems (which helps the schizophrenic) after brain injury decreases cortical functioning, worsens cognitive deficits, leads to more confusion and disorganization, and thus poorer thinking and increased agitation.”

    http://www.getrealresults.com/tenmyths.html

    DEBUNKING TEN MYTHS OF “RECOVERY”

    “Risperdal® should be a drug of last resort. The adverse event profile is so significant, you don’t want to use it except as a last resort. There are many alternatives to these kinds of drugs. But ‘big pharma’ and the FDA have failed to protect the public” – Stephen Sheller on The American Law Journal.

    http://psychrights.org/states/alaska/CaseXX/S13116/GraceJacksononRisperdalIrreparableHarmAffidavit.pdf

    http://psychrights.org/states/alaska/CaseXX/3AN-08-493PS/JacksonOnNLtoxicity.pdf

    RISPERDAL

    “In view of these considerations, risperidone should be prescribed in a manner that is most likely to minimize the risk of TD. As with any antipsychotic drug, risperidone should be reserved for patients who appear to be obtaining substantial benefit from the drug. In such patients, the smallest dose and the shortest duration of treatment should be sought. The need for continued treatment should be reassessed periodically.”

  9. I’ve just discovered this completely brilliant post. Thank you, thank you, thank you.

  10. I have a daughter that I have said for years after the head on collision years ago that she is now diagnosed with bi polar also I kept asking the doctors if she has a TBI they treated her other injuries she was in surgery for over 18 hours she is now 24 this happened when she was 10 years of age other injuries she had facial detached retna broken femer and arm. Her father that fell back on her after was diagnosed with TBI, the seat broke and his 225 lb body landed on her.

  11. I don’t know your daughter, and I’m not a doctor, but I have heard that it’s common for tbi survivors to be diagnosed as bipolar. A brain injury often makes the brain susceptible to becoming irritable when tired, and that irritability can come out as “manic” behavior. But you’re just tired. I used to have a LOT of issues with that, after my last TBI. I was either ALL ON or all off. Making sure I get enough sleep is one way of solving that. Also, watching to make sure I don’t overdo it and get more tired than is healthy. I have been really tired, lately, because I have so much going on with me, but it’s a good tired. And I get in bed fairly early, so it’s not so bad.

    Your daughter may want to try getting more sleep and see if that helps. It’s a small thing, but it can really help.

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