Mood disorders following traumatic brain injury: identifying the extent of the problem and the people at risk

Bowen, Audrey; Neumann, Vera; Conner, Mark; Tennant, Alan; Chamberlain, M A

doi:10.1080/026990598122656

Cited by 94 publications

(37 citation statements)

References 28 publications

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“…TBI patients induce HPA axis dysfunction in the acute phase of severe TBI patients. There are significantly lower glucocorticoid levels within 2.4 days after TBI and glucocorticoid levels decrease around 4 days after TBI [8]. Hypothalamic-pituitary dysfunction may be an important reason for the rehabilitation of TBIinduced depression.…”

Section: Discussionmentioning

confidence: 99%

Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury

Luo¹,

Chai²,

Jiang³

et al. 2015

Aging and disease

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Depression is one of the most prevalent psychiatric disorders in people with Traumatic brain injury (TBI). Depression after TBI is closely related with social and psychological factors and hypothalamicpituitary -adrenal (HPA) axis dysfunction. However, there is a lack of evidence regarding effective treatment approaches for depression. A total of 68 patients with depression following closed TBI were recruited. Glasgow Coma Scale score (GCS) was employed to demonstrate the severity of neurological deficits and Glasgow Outcome Scale (GOS) was employed to measure functional outcome after TBI. The severity of depression was quantified using the Beck Depression Inventory-II (BDI-II) in line with DSM-IV. Citalopram and Prednisone were administered to subjects with normal cortisol levels or hypocortisolism separately, based on psychotherapeutic interventions. We investigated the relationship between degree of depression of TBI patients and the severity and progression of TBI with the therapeutic effects of Citalopram in combination with psychotherapeutic and Prednisone in depressed patients. There was no relationship between the severity of depression and the severity and progression of TBI. The basic treatment of psychotherapeutic interventions could partially relieve depressive symptoms. Combination of psychotherapeutic support and Citalopram significantly improved depressive symptoms in patients with normal cortisol levels, but not in hypocortisolic patients. Combination of Prednisone administration with psychotherapeutic treatment and Citalopram significantly improved depression outcome in hypocortisolic patients after TBI. Hypocortisolism after TBI may regulate depression. Combination of Prednisone with psychotherapeutic treatment and Citalopram may provide better therapeutic effects in depression patients with hypocortisolism after TBI.

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Section: Discussionmentioning

confidence: 99%

Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury

Luo¹,

Chai²,

Jiang³

et al. 2015

Aging and disease

View full text Add to dashboard Cite

show abstract

“…These include heavy drug use, lower levels of education, poor work history, poor family support, and occurrence of the TBI as a result of a suicide attempt or during "high risk" behavior [6,7]. One study found that higher levels of cognitive skills were associated with lower levels of emotional disturbance, but did not find a relationship between age, sex, education, marriage, or severity of TBI and depression [8]. Post-TBI depression is associated with a more difficult overall recovery [3].…”

Section: Depressionmentioning

confidence: 94%

Emotional disturbances following traumatic brain injury

Hurley

Taber²

2002

Curr Treat Options Neurol

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Mood disturbances are common sequelae of traumatic brain injury (TBI), but the scientific database for such disorders is very limited in descriptive, prognostic, and treatment data. Post-TBI symptoms often cross diagnostic boundaries and include cognitive loss, amotivation, psychosis, mood, changes, or other domains. The treating physician must be mindful that clear diagnostic boundaries may not exist. Premorbid level of functioning commonly affects post-TBI level of functioning. When setting treatment goals, this must be considered. Patients who had lower levels of psychosocial functioning before the injury may not fare as well afterwards. Treatment of post-TBI mood symptoms should proceed after a full diagnostic work-up including imaging and electroencephalographic (EEG) studies, neuropsychologic testing, and physical and laboratory examinations. Once the diagnostic picture is established, treatment should then proceed with a multidisciplinary team (physician, social worker, neuropsychologist, and others). For the medications, consider both target symptoms and side effects; start medications with low doses and raise slowly, give full therapeutic trials before switching or adding second agents, avoid benzodiazepines if possible, limit anticholinergic or antidopaminergic agents, and avoid providing large quantities of lethal medications. When starting medications for the treatment of mood disorders following TBI, several general principles of treatment in this population should be considered, including: balancing treatment of target symptoms with the potential for adverse effects; making use of side effects to treat comorbid problems when present (ie, relatively antidepressant for depression and marked insomnia); using a "start low, go slow" approach; continuing dose escalation to full therapeutic levels (ie, completing therapeutic trials) before switching or adding augmenting agents; avoiding agents with predictable and functionally important adverse effects (ie, benzodiazepines, strongly anticholinergic or antidopaminergic agents); and avoiding prescription of large and potentially lethal quantities of medications.

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“…The incidence of people with traumatic brain injury who experience disturbances of mood and affect ranges from 26% to 77% (Bowen, Neumann, Conner, Tennant, & Chamberlain, 1998;Prigatano, 1999;Schramke, Stowe, Ratcliff, Goldstein, & Condray, 1998). These disturbances may appear in the form of anger, restlessness, frustration, irritability, agitation, anxiety, sadness, or loss of motivation (Prigatano, 1999).…”

Section: Trauma and Adjustmentmentioning

confidence: 98%

Song Collage Technique: A New Approach to Songwriting

Tamplin¹

2006

Nordic Journal of Music Therapy

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Song Collage Technique is a therapeutic songwriting intervention. The presentation and discussion of this technique provides music therapy clinicians with detailed resources, consistent terminology with which to describe treatment, and therapeutic applications for clients who have cognitive impairments, difficulty articulating feelings due to cultural or gender issues, or time restrictions in therapy. A discussion of traditional therapeutic songwriting techniques provides a foundation for the evolution of Song Collage Technique. Trauma, disability and the need for emotional expression in rehabilitation are presented to provide a clinical context for the use of Song Collage Technique. Case examples and contraindications are offered to highlight clinical application of the technique with clients undergoing rehabilitation for spinal cord injury and traumatic brain injury.

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Mood disorders following traumatic brain injury: identifying the extent of the problem and the people at risk

Cited by 94 publications

References 28 publications

Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury

Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury

Emotional disturbances following traumatic brain injury

Song Collage Technique: A New Approach to Songwriting

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