A Multipronged Intervention for Treatment of Psychotic Symptoms from Post-football Traumatic Brain Injury in an Adolescent Male: A Case Report

Abstract

Traumatic brain injury (TBI) is common among childrenaggression and disinhibition) are the most common psychological changes following a TBI in children and adolescents. 7,8Depression and anxiety can also develop following TBI. 9 In some individuals, such symptoms resolve within weeks, while in others, these symptoms remain for years, and a history of multiple TBIs increases risk for developing chronic depression and cognitive impairments later in life. 10Hallucinations are a less common form of psychological illness following TBI.11-15 Estimates of psychotic symptoms (e.g., hallucinations and delusions) are calculated to be present in as many as 20 to 25% of all TBI cases, and the presence of psychotic symptoms does not seem to be related to severity of head injury. 13 TBIs also increase the risk of developing chronic psychosis symptoms (e.g., schizophrenia 16,17). In a recent case, 11 a male with a history of TBI in early adulthood reported experiencing ongoing auditory hallucinations for 30 years, starting within a year of enduring a TBI. This patient was treated pharmacologically (i.e., with an antipsychotics and an anticonvulsant) and with group Keywords ► adolescent TBI ► psychosis ► Acceptance and Commitment Therapy ► family therapy AbstractIntroduction Traumatic brain injury (TBI) is common in adolescents. TBI can result in impaired cognitive functioning and mood disturbance. In some cases, TBI results in psychotic symptoms. There is little documentation for treatment of psychotic symptoms resulting from TBI.Case presentation The present case study reviews an adolescent male who was seen in an outpatient behavioral health clinic, following a football-related TBI. The TBI resulted in postconcussive syndrome including psychotic symptoms (i.e., visual and auditory hallucinations) and increased anxiety. Management and Outcome The adolescent underwent 12 individual sessions of Acceptance and Commitment Therapy (ACT) and 7 sessions of family therapy for his anxiety and psychotic symptoms. He also underwent Vestibulo-Ocular Therapy. At the end of treatment, the patient's anxiety symptoms and those related to post-concussive syndrome were in remission with no hallucinations experienced for >6 months. Discussion The results provide encouragement for systematic randomized controlled trials of individual and family behavioral interventions as part of an integrated treatment approach for mild TBI.

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

“… Notes a Two research articles [ 67 , 100 ] reported two studies of different study designs and as such, data reported on study design are for 61 studies b All case studies c Excludes case studies; two before-after without control group, three controlled interventions d All conducted in the United States e Sixteen studies [ 49 – 51 , 53 , 62 , 67 , 68 , 74 , 76 , 83 , 89 , 90 , 92 , 99 , 103 , 104 ] examined integrated care for individuals with TBI and more than one type of MHSU f Some studies include more than one type of treatment and as such, the number of articles reported across treatment types exceeds 49 studies ED: Emergency department; MHSU: Mental health disorders or substance use; OT: Occupational therapy; PTSD: Post-traumatic stress disorder; rTMS: Repetitive transcranial magnetic stimulation; TBI: Traumatic brain injury …”

“… e Sixteen studies [ 49 – 51 , 53 , 62 , 67 , 68 , 74 , 76 , 83 , 89 , 90 , 92 , 99 , 103 , 104 ] examined integrated care for individuals with TBI and more than one type of MHSU …”

Psychological Interventions for Individuals With Acquired Brain Injury, Cerebral Palsy, and Spina Bifida: A Scoping Review

“…Commonly identified psychological interventions used with individuals with childhood onset ABI and CP were acceptance and commitment therapy (ACT) ( 34 , 37 , 38 , 40 ), psychotherapy ( 39 , 41 ), and CBT ( 33 , 35 , 36 , 42 , 43 ), in combination with components of family therapy ( 34 ), psychoeducation ( 33 , 36 , 43 ), and Stepping Stones Triple P (SSTP) ( 40 ). Studies reporting on ACT were limited to individuals with childhood onset ABI, while studies investigating the use of psychotherapy only included individuals with CP.…”

“…Mindfulness and cognitive defusion were key techniques used. Interventions involved group therapy sessions ( 37 , 38 , 40 ), with one study involving individual sessions ( 34 ). Groups ranged from two to six people.…”

“…Groups ranged from two to six people. ACT interventions were also used in combination with family therapy with parents and children with ABI ( 34 ), and in combination with Stepping Stones Triple P (SSTP), a parenting program aimed at preventing child behavioral and emotional difficulties ( 40 ). ACT interventions all occurred in person.…”