Treatment of Psychiatric Problems After Traumatic Brain Injury

Psychiatric sequelae and interventions in critically ill trauma survivors

“…Therapeutic interventions generally focus on the domains of pharmacotherapy and psycho-behavioural therapy [14 ▪ ]. In addition, treatment can be categorized by timing, with acute treatment occurring immediately to within days of trauma, intermediate treatment occurring during hospitalization and delayed treatment following hospital discharge.…”

“…Specifically, sertraline, paroxetine, fluoxetine and venlafaxine have been found to be beneficial; however, antidepressants overall have been associated with an increased risk of seizures [14 ▪ ]. Quetiapine has been found to increase engagement and completion of cognitive processing therapy in veterans with PTSD [14 ▪ ]. Overall, evidence for betablockers has been equivocal, however, and have demonstrated efficacy in randomized controlled trials (RCTs) for anger, aggression and agitation in the absence of mood or psychotic symptoms [2,14 ▪ ].…”

“…Quetiapine has been found to increase engagement and completion of cognitive processing therapy in veterans with PTSD [14 ▪ ]. Overall, evidence for betablockers has been equivocal, however, and have demonstrated efficacy in randomized controlled trials (RCTs) for anger, aggression and agitation in the absence of mood or psychotic symptoms [2,14 ▪ ]. Although benzodiazepines may be necessary in the immediate posttrauma period for hyper-arousal and the short-term treatment of severe anxiety, long-term use may put patients at a higher risk for PTSD and other psychological disease [2,14 ▪ ].…”

“…However, a meta-analysis in post-trauma patients did not find CBT-based interventions to be more effective than usual care in decreasing or preventing psychiatric sequelae in trauma survivors [15]. Behavioural therapy interventions, such as CBT, require learning and information processing, which are often impaired in trauma [14 ▪ ]. Prolonged exposure therapy is a trauma-focused psychotherapy, involving a therapist utilizing imaginal exposure and in-vivo exposures to access trauma memories [13].…”

“…Other treatment applications under investigation include virtual reality and ecological momentary intervention (EMI), utilizing new technologies that may be able to improve cognitive therapies in the future [14 ▪ ]. Neuro-modulatory therapies such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are also areas of future research [14 ▪ ].…”