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What can be done to help with mood and behavior disorders caused by brain injury?
Moodiness and behavior disorders frequently occurs following a severe brain injury. Under the of care of a neuropsychiatrist (a psychiatrist specializing in brain-related disorders), medications are often used to stabilize the disposition of persons with a brain injury. In addition to, or instead of medication, a behavior management plan put together by a neuropsychologist (a psychologist specializing in brain-related disorders) may help to reduce the extent and frequency of mood swings. Such a plan might focus on helping the individual increase his or her awareness of when a swing may occur and train the person in alternative behaviors. Persons plagued by mood swings must be motivated for change for this strategy to work.
In situations where impulse control have followed brain injury, psychiatric or neuropsychiatric intervention helps to correct the underlying brain chemical (neurotransmitter) alterations that have been well described to occur following brain injury. These medications are intended to return the brain environment to the relative amounts of neurotransmitters which will assist the patient in regaining appropriate behavioral controls. The use of medications exclusively should be avoided. A better approach would be the combination of appropriate pharmacological intervention and behavioral/psychotherapeutic intervention to assist the individual in adapting to his residual neurologic impairment.
Before a medication is prescribed by a psychiatrist, he/she should review the patient's problems. Many individuals after brain injury may be on several medications. These may have side effects, including depression and irritability. If possible, these medications may be changed or discontinued if not still required. Other emotional symptoms may guide the choice of medication.
Medications that can prove helpful include antidepressants such as sertraline (Zoloft) and fluoxetine (Prozac), mood stabilizers such as valproic acid (Depakote), and several others. There are several important guidelines that should be followed. Medications, in general, should be started gradually, as individuals with brain injury are more sensitive to side effects than are those without brain injury. When a medication is prescribed, it is important that it be given a chance to work (what is called a "therapeutic trial"). This includes time on the medication and the dose administered. Medications will improve emotional control and decrease depression and irritability. But remember that medications are not a cure.
Behavioral changes may alienate family and friends, with families sometimes perceiving the person as a "difficult stranger." Ignorance and misperceptions of families, coworkers and healthcare professionals about the effects of TBI may make matters worse. Behavioral management may be necessary to increase independence and reduce maladaptive social behavior: agitation, irritability, combative outbursts, lethargy and abnormal or foul language.