At the Patient Advocate of the Sierras, we recognize that March is Brain Injury Awareness Month.
Brain injuries can often be mistaken for psychiatric disorders. It is crucial that any patient reporting a recent assault or potential head trauma undergoes a comprehensive neurological examination by a qualified neurologist before receiving psychotropic medications or psychiatric treatment.
Healthcare providers are required to make a reasonable effort to obtain an accurate history and screen lab work for things which could present as a psychiatric disorder, such as a urinary tract infection, before medically clearing a patient for psychiatric care.
Administering certain psychotropic medications to a patient with a brain injury can delay healing, or worse, cause further damage, and should only be used as a last resort.
Clinical Assessment
Glasgow Coma Scale: A 15-point test that evaluates mental status, eye movements, and reflexes.
Neurological Exam: Tests strength, balance, coordination, and reflexes.
Cognitive Exam: Assesses concentration and recall ability.
History: Inquires about the injury and its circumstances.
Blood Tests
Brain Trauma Indicator: Measures proteins released into the blood following a mild traumatic brain injury (TBI).
Other Tests
Electroencephalogram (EEG): Records brain activity using electrodes attached to the scalp.
Eye Movements: Assesses brain function.
Brain Wave Patterns: Evaluates brain function.
Treating a Head Injury vs. Providing Psychiatric Treatment:
Addressing a brain injury before initiating psychiatric treatment is essential.
A brain injury can significantly affect cognitive function, emotional regulation, and behavior, often masking or mimicking psychiatric symptoms.
This makes accurate diagnosis and effective treatment of mental health issues difficult without first addressing the underlying neurological damage. In essence, treating the brain injury ensures that any observed mental health symptoms are not solely a result of neurological impairment.
Key Reasons for Prioritizing Brain Injury Treatment:
Accurate Diagnosis: Symptoms such as irritability, mood swings, difficulty concentrating, and memory issues can arise from both psychiatric disorders and brain injuries. Proper assessment and management of the brain injury are vital for accurate diagnosis.
Treatment Effectiveness: Psychiatric interventions may prove less effective if underlying neurological deficits from a brain injury are unaddressed, potentially leading to poor treatment outcomes and frustration for the patient.
Avoiding Inappropriate Medications: According to medical information, psychotropic medications that are considered dangerous for a head injury include:
Atypical antipsychotics (like olanzapine and risperidone)
Benzodiazepines (like Valium or Ativan)
Most typical antipsychotics (like haloperidol or chlorpromazine)
High doses of opioids (OxyContin, Vicodin)
Key points about these medications and head injuries:
Atypical antipsychotics: (Zyprexa, Risperdal)
Considered dangerous for someone with a head injury, as they may worsen confusion and potentially delay cognitive recovery following a traumatic brain injury (TBI); therefore, other treatment options should be prioritized.
Key points about olanzapine, risperidone, and head injuries:
Sedative effects:
Olanzapine can cause significant drowsiness, which could further impair cognitive function in a person recovering from a head injury.
Potential for confusion:
Using olanzapine may increase confusion and prolong post-traumatic amnesia (PTA) in patients with TBI.
Limited evidence for efficacy:
Research supporting the effectiveness of olanzapine and risperidone is limited and concerns regarding cognitive impact and delay of healing remain.
Benzodiazepines: (Ativan, Xanax)
Can cause excessive drowsiness, impair cognitive function, and potentially delay recovery from a head injury, making them generally avoided unless absolutely necessary.
Typical antipsychotics: (Haldol, Thorazine)
These medications can have strong sedative effects and may interfere with neurological recovery after a head injury.
Opioids: (OxyContin, Vicodin)
While sometimes used for pain management, high doses can increase intracranial pressure and further impair consciousness, requiring careful monitoring.
Important Considerations for Effective Brain Injury Treatment:
Consult a Doctor Who Specializes in Neurology and Traumatic Head Injuries:
Always discuss any medication use with your doctor after a head injury, as they can advise on the most appropriate treatment based on the severity of the injury.
Tailored Treatment Plan:
Recognizing the specific cognitive and behavioral impairments caused by a brain injury enables the creation of a personalized treatment plan in the psychiatric setting, addressing the unique challenges faced by the individual.
Prioritizing Neurological Treatment:
Managing neurological symptoms of a brain injury may enhance the individual’s ability to engage in and benefit from psychiatric treatment, if an underlying psychiatric disorder exists.
Collaboration Between Specialists:
Optimal care often involves collaboration among neurologists, neuropsychologists, and mental health professionals to ensure comprehensive evaluation and treatment.
References:
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