Brain Injury and Psychiatric Symptoms

Abstract: Clients who are thought to have psychiatric illness, like depression or problems with concentration, may have traumatic brain injury. Psychiatric treatment may relieve some symptoms but there may be over riding issues that need to be addressed to assure that appropriate treatment is being provided.

I just read in the January 7,2006 USA today, about a soldier in Iraq who suffered a concussion after a bomb explosion. It was the third time in his life that he had suffered a concussion. The article quotes Deborah Warden, who is the director of the Defense and Veterans Brain Injury Center, which is part of the Department of Veterans Affairs and the Pentagon as saying that although mild brain injuries may not cause severe damage, repeated injuries could cause permanent damage. The article reports that symptoms of brain damage are: “slow thinking, headaches, memory loss, sleep disturbance, attention and concentration deficits and irritability”.

This article brings to mind client that I evaluate from time to time. One particular client, a 28 year old male, who was divorced from his wife, walked in asking for a psychiatric evaluation. He said he was sad. He lives in the area but reports that he is continually confused, he has memory problems, is slow thinking and acts bizarrely. He just wanted to feel happy again.

He is well noted in the clinic, because a young female case worker was attempting to assist him with obtaining health benefits and the patient asked her out and when she told him she couldn’t because it would be inappropriate, he persisted, to the point where I needed to intervene. During his evaluation I learned that the patient suffered a head injury when he was a child and was struck in the head with a back hoe when he was working in construction a few years ago. Then, his symptoms appeared to become much more severe when he was in a car accident and struck his head on the wind shield. These separate events were evaluated and the patient reports that he was never advised that his injuries had caused mental defects. When his father came in for a follow up evaluation; the father was surprised that the patient was being considered for psychological testing and a neurological evaluation. The father told me, “He’s always so sad and angry, but we just thought he was depressed.”

Summary: Psychiatric professionals should evaluate for any history of brain injuries when evaluating clients. All to often, I find that due to a variety of issues, questions about brain trauma, head aches and seizures are not asked and this could be a serious dis-service to the client. It could result in inaccurate or inappropriate treatment.

Hydration: Preventing Psychiatric and Physical Symptoms

As a Psychiatric Nurse Practitioner and Naturopath (ND), I am very concerned with my clients fluid replenishment. The human body eliminates approximately two liters of fluid in a day through perspiration and elimination. I have clients who come to see me for psychiatric evaluation and tell me they feel dizzy. As I mentioned in previous blogs, I try to keep everything simple (KISS). So, the first thing I ask my clients is, “how much water, and other fluids do you drink in a day?” (The second is – “How much sleep and rest have you had recently”– see my other blogs): It is important to replenish the two liters and then some to keep properly hydrated, so one needs to drink 8 cups of fluid, preferably, purified water.*

The first thing I do is take the person’s blood pressure – I take it on each client – at each visit. If a clients’ blood pressure, when seated, is significantly different (higher) than their blood pressure when they stand up, then, it could conceivably be the cause of the dizziness. This is called postural hypotension. The amount of fluid intake is one possible explanation for this problem, of course there are others. Another simple explanation, is: Does the client have a diagnosis of Hypertension? Then, I would look at how my client is taking his/her medications. Since blood pressure fluctuates, some people take their medication, without checking their blood pressure and pulse. The problem is obvious. Take a “blood pressure pill” when your blood pressure is down and it could cause a number of symptoms including dizziness.

Of course there are other reasons for dizziness and their psychiatric medication could be causing it, but, I look at this as a cause when the patient has just started a medication or if the client has recently changed their “medication recipe” (what I call their medication regime).

Certainly, if I am not satisfied that the dizziness is not easily diagnosable, I will suggest further testing and may refer my client for further evaluation by their primary care practitioner or send the client to the urgent care clinic for evaluation.

Summary: A symptom of dizziness is a significant symptom, but it is prudent to look at possible simple causes. Of course dizziness must be evaluated to the satisfaction of the practitioner before the client leaves the office, with an appropriate treatment plan, but it is my firm belief that clients should have more control over their health so reviewing fluid intake and reviewing their sleep regime are two important methods of helping my clients to have an impact on their good health.

* http://www.cnn.com/HEALTH/library/NU/00283.html