Transcript Traumatic Brain Injury and Behavioral Health Co


Posttraumatic Stress disorder (PTSD) is an
anxiety disorder that can occur after you have
been through a event. A traumatic event is
something horrible and scary. During the event
, an individual believes that his/her life or the
lives of others are at risk.
Combat or military exposure
Childhood sexual or physical abuse
Terrorists attacks
Sexual or physical assaults
Serious accidents, such as a car wreck
Natural Disasters, such as a fire, tornado,
flood or earthquake

The recent RAND Center for
Military Health Policy Research
“Invisible Wounds of War Psychological and Cognitive
Injuries, Their Consequences, and
Services to Assist Recovery”
report on OIF/OIE veterans,
discussed that of the1.64 million
service members who have been
deployed for OIF/OIE as of
October 2007, they estimate that
300,000 individuals currently suffer
from PTSD or major depression
and that 320,000 individuals
experienced a probable TBI
during deployment.
Rand Study:
1. 69.3% have no
diagnosis
2. 11.2% PTSD or
depression
3. 7.3% have
PTSD/Dep/TBI
4. 12.2% have TBI only



Estimated prevalence of lifetime PTSD to be 7.8% in
the general population.
Women are twice as more likely to than man to
develop PTSD at some point in their lives.
Men are more likely to experience a trauma.
( National Center for PTSD)
1.Had an earlier life-threatening event or
trauma, such as being abused as a
child
2.Poorly educated
3.Younger age
4.Having another mental health
problem
5.Family with mental health problems
6.Limited support from friends and family
7.Recent loss of a loved one
8.Recent stressful life changes
9.Alcohol abuse
10.Female





Bad dreams
Flashbacks
Scary thoughts
Staying way from
places and things
that remind you of
what happened
Feeling worried,
guilty, or sad





Feeling alone
Trouble sleeping
Feeling on the edge
Angry outbursts
Thoughts of hurting
yourself or others
Regression: behaving like they did when
they were younger
 Somatic preoccupations
 Behavioral Disruptions
 Poor School performance
 Refusing to play or play with friends.

A traumatic brain injury is defined as a blow
or jolt to the head or a penetrating head
injury that disrupts the function of the brain.
Not all blows or jolts to the head result in a
TBI.
Degree of Injury:
Injuries may range from mild( brief changes in
mental status) to severe (extended periods
of unconsciousness or amnesia after the
injury.
TBI can result in short or long-term problems
with independent functioning (CDC,2006)
Traumatic brain injury
is classified as a public
health epidemic in
America.
Centers for Disease Control and Prevention. “Traumatic Brain Injury in
the United States: A Report to Congress.” (January 16, 2001).
1. Military personnel
 2. Males are about 1.5 times more likely
than females to sustain TBI

Cost:
 Direct medical cost and indirect cost such
as the loss of productivity of TBI totaled $60
billion in the U.S. in 2000 (Finkelstein,2006)

Centers for Disease Control and Prevention
Annual
1.4 million injured
50,000 die from a TBI
235,000 are hospitalized
1.1 million treated and released from ED
5.3 million, approximately 2% of the U.S. population,
currently have a long-term or lifelong need for help to
perform activities of daily living as a result of a TBI.

The number reported with TBI
underestimates the magnitude of the
problem because the following are
not included in those estimates:
› Those treated by private physicians.
› Those treated in private clinics, urgent
cares.
› Individuals who did not seek medical
care.
The leading causes of
TBI are:
 Falls
 Motor vehicle-traffic
crashes
 Struck by/against
events
 Assaults
› (Defense and Veterans
Brain Injury
Center,2005)
In intimate partner violence,
the head and face are
targeted half the time.
In non-intimate assaults
against women, nearly 60%
of the assaults are to the
head and face.
Greenfield, L. Et al, Violence by Intimates, NCJ-167237, US
Department of Justice, Bureau of Justice Statistics, March 1998
Many children have
neurological deficits
caused by repeated
blows to the head and
face and/or by the
chemical reaction to
prolonged stress of
witnessing and living
in a violent home.
…Physical, sexual and
psychological trauma in
childhood are now being
connected to mental
health difficulties, that
show up in childhood,
adolescence, or
adulthood.

The report further discussed
that
› Of those reporting a probable
TBI, 57 per cent had not been
evaluated by a physician for
brain injury
› Some specific groups that
were understudied (e.g.
Reserve Components, those
who left military service) may
be at higher risk for suffering
from these conditions.

Mild TBI: headaches, confusion,
lightheadedness, dizziness, blurred vision,
ringing in ears, bad taste in mouth, fatigue,
sleep disturbance, mood changes,
decrease memory, difficulty with
concentration, attention or thinking. The
injury may or may not result in a brief
period of unconsciousness
(TBI Recovery Center,2006)

Moderate or Severe TBI: symptoms may be
similar to mild but they may also include a
headache that gets worst and never goes
away, repeated vomiting or nausea,
convulsions or seizures, inability to awaken
from sleep, dilation of one or both pupils of
the eyes, slurred speech, weakness or
numbness in the arms or legs, loss of
coordination, increased confusion,
restlessness, or agitation.
( TBI Recovery Center,2006)
5.3 million Americans have long-term or
lifelong need for help to perform daily
living(Thurman,1999)
 40% of those hospitalized for TBI had at least
one unmet need for services. The most
frequent unmet needs:
a. Improving memory and problem solving
b. Managing stress and emotional upsets
c. Controlling one’s temper
d. Improving one’s job skills
(Corrigan,2004)


There is a potential for symptoms to be dismissed,
rejected, misdiagnosed, or misunderstood due to
a delay in the manifestations of some of the
symptoms and the similarities to mental illness.

Individuals may be presenting with possible
psychiatric illnesses where brain injury is really the
underlying cause or driving the illness.

Cognitive changes following brain injury may
impair the individual’s ability to access and use
cognitive behavioral strategies.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
TBI
Increased anger/irritability
Rage
Depression
Memory impairment
Sleep disturbance
Headaches
Avoidance of
crowds/social isolation
Substance Abuse
Suspicion/paranoia
Anxiety
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
PTSD
Increased anger/irritability
Rage
Depression
Memory impairment
Sleep disturbance
Headaches
Avoidance of crowds/social
isolation
Substance Abuse
Suspicion/paranoia
Anxiety
(Brain Injury Association
of
Arizona)
1.
2.
3.
4.
5.
6.
7.
TBI
Impaired decision
making
Work retrieval
problems
Low frustration
problems
Low frustration
tolerance
Impulsive behavior
Noise Sensitivity
Easily confused
1.
2.
3.
4.
5.
6.
PTSD
Easily Startled
Hyper-vigilant of
surroundings
Strong reaction to
flashbacks
Nightmares
Intrusive thoughts
Guilt
(Brain Injury Association of
Arizona)

Cognitive, emotional, and/or behavioral challenges
after brain injury can result in referrals to systems and
services that do not have adequate knowledge,
understanding, training, and/or experience working
with individuals with brain injury and their families.

This may result in:
› inappropriate evaluations, assessments and
treatment;
› inaccurate assessment of response to treatment;
› exacerbation of symptoms;
› Inappropriate medications or overmedication;
› Substance abuse.