Management of late mental sequelae General management principles

Good medical and surgical care, followed by transfer to appropriate rehabilitation services is required to optimize recovery from head injury. In addition, the individual and their family should have access to support as they try to adjust to the changes forced on them by the head injury. Education, and access to information, is an important part of the strategy.'65) Not infrequently psychological problems arise if any part of this process has not gone smoothly, or is perceived to have failed. The psychiatrist should explore any such concerns.

It is often necessary to find out what services are available in the area that might provide rehabilitation or support. Access to suitable programmes of rehabilitation, or vocational training, or appropriate support, may relieve mental symptoms. A social worker should be asked to undertake a community care assessment, which may identify the need for respite care or modifications to the home.

Specific neuropsychiatric interventions

It is important early on to ascertain the degree of brain injury that has been sustained. If there is any doubt then this may need to include a neuropsychological assessment. The severity of brain injury will suggest whether a particular symptom is mainly due to brain injury or to psychological processes. This will influence management.

Cognitive-behavioural treatment will play a key part in the management of neurobehavioural symptoms. Behavioural strategies are particularly relevant to behavioural problems arising from brain injury. (66> The crucial task is to identify the responses of carers or family that seem to be reinforcing the behaviour.

Pharmacological management

Perhaps the majority of patients who suffer a traumatic brain injury, needing hospital treatment, are given psychotropic drugs, (6Z> despite the fact that animal studies suggest that some may interfere with recovery from brain injury. Patients should be given psychotropics only if absolutely necessary, using the principles described in BoxJ and avoiding multiple drugs given concurrently.

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