The presentation of behavioral health difficulties resulting from a traumatic brain injury (TBI) are often seen immediately after the injury and may linger for an indefinite period of time. Psychiatric symptoms and behaviors present challenges to the patient, family and treating clinicians. Psychological trauma resulting from the event that led to the TBI, such as combat associated explosions, motor vehicle accidents and serious falls, can cause post-traumatic stress disorder (PTSD) which may complicate recovery.
According to Brian Bronson, MD, Clinical Associate Professor and Director of Consultation and Liaison Psychiatry at Stony Brook University’s School of Medicine, neuropsychiatric manifestations of a TBI generally appear early after the injury.
“Persons with a severe TBI with a prolonged loss of consciousness often awaken with an initial period of delirium,” he notes. “This generally includes impairments in multiple domains of cognition, such as attention, orientation, memory and executive function, and may also include behavioral disinhibition and affective instability among other psychiatric symptoms.”
According to Bronson, medical and surgical providers working with patients in intensive or acute inpatient medical and surgical settings often describe the behavior as agitated. Disorganization of behavior, including pulling out of intravenous lines is also common, making the immediate care of the patients challenging for nursing staff when trying to ensure patient safety and proper care. Families may express concern and ask questions about potential long-term personality change. Educating families early on about the potential short and long term effects helps to mitigate frustration with the injured person and sets realistic expectations of long-term outcomes.