CLINICAL COVERAGE
According to American Brain Injury Association, there are more than 5 million children and adults who live with permanent disability related to brain injury, and at least 2.8 million people in the United States suffer a traumatic brain injury each year. To help bring attention to what can be preventable disability and to focus on ways to support brain injury patients, March is commemorated as Brain Injury Awareness Month.
Psychiatric timeMT invited Matthew J. Ashley, MD, JD, to discuss some of the overlap between brain injury and psychiatric symptoms and illnesses.
Psychiatric timeMT: What should psychiatrists be aware of to better help their patients prevent brain damage?
Matthew J. Ashley, MD, JD: The prevention of traumatic brain injury (TBI) is a problem that would be great to solve. Unfortunately, humans are pretty poor at assigning relative risk to low-probability events. I guess the most practical advice I can offer is to pay attention to the most common situations that lead to TBI and try to educate others about those risks.
Believe it or not, the most common cause of TBI is not car accidents, but falls. So if your patient works in an industrial job where there is a risk of injury on the job, remind them to follow safety protocols.
Also, remind patients to wear a seat belt. And, if you’re driving anything with two wheels – not just a motorcycle but also a bicycle – then wear a helmet and drive the vehicle defensively.
PT: Much attention has been paid to brain damage resulting from accidents and sports, what are other common causes of brain damage? What is the impact of the causes of brain damage on treatment and prognosis?
Ashley: The most common cause overall is falling, and even a fall at ground level, if done in the right way, can cause significant brain damage. Other high-risk activities may seem obvious once you consider the nature of the activities, but it might not seem so obvious otherwise. This includes equestrian activities, downhill activities, skateboarding, etc. Essentially anything where someone is operating at a height above the ground or accelerating rapidly through space.
Firearms incidents, whether accidental or intentional and related to assault or suicide, are another common cause.
Finally, although it does not cause traumatic brain injury, another common and often preventable cause of brain injury is anoxic injury, which can be due to many causes, including cardiac arrest or respiratory arrest. Both are, unfortunately, all too common due to drug overdose. The cause of injury can certainly impact a patient’s prognosis. It’s a complicated discussion, and each patient is, of course, unique.
PT: We are still learning about the impact of COVID-19 on the brain. What are the most common neuropsychiatric symptoms associated with brain damage from the virus or time spent on a ventilator?
Ashley: As I mentioned, respiratory or cardiac arrest can lead to anoxic brain injury. COVID-19 is also associated with ischemic stroke, which is another form of brain injury.
We are still learning about the other more direct consequences of COVID-19 on the brain, but many effects have been reported, ranging from anosmia (i.e. lack of sense of smell), cognitive impairment (which has sometimes been colloquially referred to as brain fog), to more severe forms of encephalitis that occur later in the course of the disease as a likely autoimmune consequence.
In addition, there is a post-ICU syndrome, including the traumatic experience of critical illness, social isolation, and any other forms of critical illness myopathy or neuropathy that patients might experience after a long course in care. intensive.
PT: With the popular press attention around CBTs, have we seen a decrease in their prevalence?
Ashley: It’s hard to determine. With increased awareness of TBI, it is possible that we have increased our detection of milder cases, resulting in apparently higher prevalence figures. Conversely, with awareness and better adherence to safety measures such as seat belts, helmets and concussion protocols, we are likely reducing the actual number of cases that are occurring, but it is quite difficult to understand all of this entirely.
PT: Does the treatment of brain injury differ for patients with severe mental illness?
Ashley: Obviously there are some differences, in that we have to treat the underlying mental health condition and the brain injury simultaneously, but the fundamentals of treating brain injury don’t change all that much. And, I may be biased, but I believe that the comprehensive, cognitive, behavioral, medical, and therapeutic treatment paradigm we use to treat traumatic brain injury likely has other coincidental benefits for people with TBI. other mental health disorders.
PT: Anything else you wish psychiatrists knew about brain damage?
Ashley: I would say that every psychiatrist should know that there is help for CBT survivors, that comprehensive and dedicated programs exist and that they can be beneficial even long after the initial injury.
Dr. Ashley is the chief medical officer of the Center for Neuro Skills, which runs post-acute brain injury rehabilitation programs. He is also a Visiting Assistant Clinical Professor in the Department of Neurology at the University of California, Los Angeles.
