i) Challenges inherent in the disease process

There are a number of challenges that are inherent in the disease process itself that cause significant problems for the psychiatrist when making an assessment.

The illness related factors are both within the traumatic brain injury but also with the psychiatric illness.

For example, people who are psychotic have an impairment of awareness and a brain injured person may also have an impairment of awareness. Overall the impairment of awareness produces a substantial challenge in relation to diagnosis. In this situation involving family members will help us to become increasingly aware of what the difficulties are within the patient.

Some brain injury consequences can be like a psychiatric illness, depression and apathy are examples.  A psychiatrist may be able to distinguish between apathy and depression following brain injury.

A person with a brain injury they can often have problems with motivation and be described as being apathetic. Apathy is an organic state often related to damage to the basal part or the lower part of the frontal area,  this apathy can be measured using rating scales.   But apathy and depression can be very similar and therefore it becomes a challenge for psychiatrists to be able to distinguish between them.

It can be difficult to decide between when things are normal and when they have become an abnormal state - anxiety and anxiety symptoms is one of these situations.

Someone who has had a traumatic brain injury can not do a number of things, they are unable to work, they may have financial difficulties. That anxiety may be a normal concern and deciding when it becomes a disorder that needs treatment can provide a significant challenge.

It is the same with regards to the obsessiveness that we can see in some brain injured patients. When is obsessiveness useful, when does it become a disorder?

Therefore the combination of traumatic brain injury and psychiatric illness produces particular challenges with diagnosis.

 

ii) Questions