Program of Enhanced Psychiatric Services for Patients With Brain Injury and Neuropsychiatric Disturbances: A Proposed Model of Care.

Neuropsychiatric disturbances associated with brain injury occur frequently and are a common cause of poor quality of life and caregiver burden. These disturbances can disrupt rehabilitation therapies and contribute to functional impairment if they are not appropriately treated. Although some patients can be treated adequately in an outpatient brain injury clinic or rehabilitation clinic, others need a more specialized structured program. Behavioral problems in particular are challenging and often lead to discharge of patients from traditional rehabilitation programs because their behaviors can be disruptive and/or harmful to themselves and others. These patients are often admitted to inpatient general psychiatric units, where they do not receive the comprehensive care they need. In an effort to prevent unnecessary hospitalizations and to provide comprehensive treatment, a community-based, multidisciplinary program was developed to address the physical, cognitive, and psychiatric needs of patients with brain injury. The program is highlighted with two case presentations: (a) a 31-year-old man with severe traumatic brain injury with subsequent cognitive and behavioral symptoms who had improvement in symptoms and quality of life, and (b) a 38-year-old woman with cognitive and mood symptoms after left temporal lobe resection due to medication-refractory epilepsy who had improved mood symptoms and daily life functioning. Brain injury is commonly associated with a host of neuropsychiatric symptoms that wax and wane. There is an urgent need to develop comprehensive programs that can address the multiple needs of this patient population in a community setting.

Neuropsychiatric disturbances associated with traumatic brain injury: a practical approach to evaluation and management.

Traumatic brain injury (TBI) causes a wide variety of neuropsychiatric disturbances associated with great functional impairments and low quality of life. These disturbances include disorders of mood, behavior, and cognition, and changes in personality. The diagnosis of specific neuropsychiatric disturbances can be difficult because there is significant symptom overlap. Systematic clinical evaluations are necessary to make the diagnosis and formulate a treatment plan that often requires a multipronged approach. Management of TBI-associated neuropsychiatric disorders should always include nonpharmacological interventions, including education, family involvement, supportive and behavioral psychotherapies, and cognitive rehabilitation. Pharmacological treatments include antidepressants, anticonvulsants, antipsychotics, dopaminergic agents, and cholinesterase inhibitors. However, evidence-based treatments are extremely limited, and management relies on clinical empiricism and resemblance of TBI neuropsychiatric symptom profiles with those of idiopathic psychiatric disorders. Although the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed including prospective, longitudinal studies to explore biomarkers that will assist with management and prognosis as well as randomized-controlled studies to validate pharmacological and nonpharmacological treatments. The current review summarizes the available literature in support of a structured, systematic evaluation approach and treatment options as well as recommendations for further research directions.