Psychological Consequences of ABI

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Psychological Consequences of ABI

• Dr Neil Parrett

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Mental Health Problems following ABI

• Psychosis (0.7-9.8 )
• Depression (40-60)
• Anxiety Disorders (11-70)
• Substance Misuse (9-36)
• Suicidality ( x4)
• Apathy (45-70)

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Brain Injury as an accelerant toPsychiatric
Conditions

• Thinking problems
• Executive dysfunction
• Emotional response to injury and disability
• Difficulties with self-regulation and impulse
  control
• Memory problems
• Compliance with treatment
• Social withdrawal
• Social role changes and isolation

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Psychosis

• (Paranoid) Delusions -a fixed false belief that
  is resistant to reason or confrontation with
  actual fact
• Hallucinations Visual, auditory, olfactory etc.
• Also Agitation, grimacing, silly giggling,
  expression of odd ideas, regression, and
  impulsive aggressiveness.
• Acute or chronic, transient or persistent, and
  may or may not be associated with mood
  (depression).
• Most do not have a family history of
  schizophrenia (but if do likelihood)

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Depression

• An all-encompassing low mood accompanied by low
  self-esteem, and loss of interest or pleasure in
  normally enjoyable activities.
• Fatigue, irritability, suicidal thoughts,
  hopelessness, disinterest, and insomnia.
• High Prevalence Major depression approx 25
• Long lasting Depression found in 61 of TBI
  cases average more than 7 years post injury
• (Hibbard et al, 1998)

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Anxiety

• Generalized anxiety disorder (GAD), panic
  disorder, phobic disorders and obsessivecompulsiv
  e disorder (OCD).
• TBI patients often experience generalized
  "free-floating" anxiety associated with
  persistent worry, tension, and fearfulness
• PTSD unlikely if the impact to the head had
  resulted in an extended period of
  unconsciousness.
• (Glaesser et al 2004)

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Substance Abuse

• Pre injury factors exacerbated
• OR emerging use post injury
• Self-medication, response to depression Boredom,
  loss of life focus, withdrawal and exclusion
• Family difficulties
• Loss of peer group and social network

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Substance Abuse and long term Outcomes

• Co-occurring TBI and substance abuse associated
  with lower likelihood of working, lower
  subjective well-being, increased likelihood of
  committing suicide and greater risk for seizures
• (Corrigan, 2005)

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Increased Risk for Suicide

• Diminished impulse control/ self regulation
• Decreased fear of self-injury evidenced by
  increased risk taking.
• Reduced problem solving ability
• Ability to engage in an act of lethal self harm
• Social isolation and exclusion
• Sense/belief that one is a burden and do not
  belong to a valued social group or relationships
• Highest rates among males 15-24 and 65

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Apathy

• Individual may not fully sense their altered
  role, behaviours and performance
• Ability to participate in relationships is
  reduced
• Significant response by others to changes in
  functional status ("not the same person")
• Lack of initiation of behaviors integral to role

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Apathy

• Apathy is associated with a reduced emotional and
  physical response
• Loss of role and hopelessness found in most
  individuals with apathy
• Apathy may not be concern to the individual due
  to a loss of self-observation
• Caregivers rate apathy as the third most
  difficult problem
• 83 of TBI cases with apathy also had depression
• Source Van Reekum, Stuss, Ostrander, 2005.

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Why does ABI result in poorer Mental Health?

• Physical (disability? loss of freedom)
• Cognitive (reduced cognitive functioning)
• Emotional (direct indirect consequences of ABI)

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Components of Self-Esteem

• Job, profession, skills
• Relationships, Family, Friends
• Life Activity Focus
• Home, residence ownership
• Membership in community
• Perception of individual by others/ positive
  feedback
• Participation with others in activities of value

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Four Outcomes for Living What are the affects of
a brain injury?

• Job 76 are unemployed
• House 6.1 own their own home includes
  pre-injury home ownership
• Freedom Majority are not driving, many have
  physical disabilities
• Friends Friendships are lost following TBI
• Source Condelucci, 2007, 2008

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The Individuals role in developing Mental Health

• Capacity to maintain a sense of self
• Relating abilities
• Capacity to initiate behaviour/activity
• Ability to respond/reciprocate
• Recognition of self among others

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Positive and Negative Roles

• Positive
• Survivor
• Helper
• Worker
• Caregiver
• Friend
• Colleague
• Peer

• Negative
• Helpless
• Unemployed
• Patient
• Victim

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Two Distinct Coping Styles

• Type 1 avoidance, worry, wishful thinking,
  self-blame, alcohol/drug abuse
• Type 2 actively working on problem, using humor,
  finding enjoyable activities to manage stress
• Source Curran et al, 2000

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The individual within society

• The value of a person is created by the
  individual and their society
• The roles a person occupies and their
  effectiveness in those roles creates value
• Disability and loss of role function produces a
  decline in self worth as perceived by the person
  and others Source Condelucci, 2007
• Depression and loss disrupt the persons sense of
  social stability Source Franks,et all 1996

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Barriers to social re-intergration

• Social behavior and judgment problems causing
  legal problems (range 9-33 of cases)
• Post injury substance abuse (range 9-36 of
  cases)
• Problems with spouse/significant other (range
  22-45 of cases)
• Problems with relating to/maintaining friends
  (range 50-88 of cases)
• Source NRIO Outcome Validation Study 2007

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Social networks

• Disability creates an exclusion from network
• Mutual relationships shift
• Social isolation and exclusion occurs
• Aging further enforces the isolation and
  exclusion related to disability

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Changes over time affect social networks

• Loss of skills, capacities and ability to
  participate in life activities
• Loss of primary relationships
• Isolation from friends, work and community
• Death/illness of family and caregivers
• Distancing of others from the individual
• Increase in medical problems and complexity over
  time

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Psychological approaches to mental health problems

• Developing personal strengths Goals
• Staying engaged
• Maintaining social support networks
• Support groups
• Self-help guides
• Therapeutic Interventions Cognitive
  rehabilitation, social skills training,
  vocational training, individual therapy, group
  therapy, and family therapy

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Types of therapy

• Counselling
• Cognitive Behavioural Therapy (CBT)
• Psychodynamic therapy
• Systemic therapies
• Narrative,
• Solution focused
• etc. etc.

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Accessing Help

• Talk to someone
• Research internet
• http//www.nnt.nhs.uk/mh/content.asp?PageNameself
  help (Google, Northumberland NHS Self Help)
• Headway other MH charities e.g. Mind,
  Samaritans
• Community rehab support e.g. Sweetree
• GP

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• Thank you for listening!
• Any Questions?