Trauma to the brain results in many mood and behavior problems. Depression is frequently cited after a mild head injury due to frustration and loss of self esteem.

Individuals suffer a mild brain injury whenever they are hit on the head, strike their head against an immovable object, or have had their brain strike against the inside of the skull due to whiplash or shaking. Motor vehicle accidents are a leading cause of head injury, but brains are frequently rattled in athletic events and as a result of fights and abuse. Brain or head injury is an under-reported youth sports injury.

Head injuries cause changes in mood and behavior that are noticeable to the injured. Others may view them as irritable and aggressive. The head-injured frequently endure panic attacks and depression. As the individual notices emotional and cognitive changes and struggles to control his feelings, frustration is often the result. Frustration may become so strong that the person feels like he is “losing his mind.” He becomes moody and depressed, and if left untreated his depression may spiral downward dangerously.

Doctors are becoming increasingly aware of the fact that depression lingers on after the physical cuts, bruises, and broken bones are healed. As a result, more are emphasizing the importance of including neurological rehabilitation after any bump to the head or rattle of the brain. An important aid to recovery is patient understanding and acceptance of the injury. The head-injured person has to learn not to get mad at others and himself about every event that “pushes his emotional button”.

Two Strategies to Prevent Depression’s Pull

Take control of emotions by taking a time-out when emotions rise to the surface. Get away from whatever is irritating by taking a walk or turning attention to something that is pleasing. It takes a lot of practice, but if the head-injured person sees this practice as critical to his rehabilitation he will stick to it and train himself to “get a grip” rather than explode.

Loss of language skill is another frequent brain injury trait that sparks a loss of self esteem. This can be devastating, especially to the individual who has achieved pre-injury success in a profession or leadership position. Everyone has that moment when they can’t think of the right word, but the brain-injured suffer this problem more often. The brain-injured have to work hard to “keep talking” until they find the word and not give up or think they are dull minded. Talking about it can help. Visualize the first letter, the color, or some other characteristic of the word.

You Can Do It!

Brain injury shouldn’t rob a person of true emotions and self esteem. If you are brain injured or are the caregiver of a brain-injured person, seek out doctors who understand brain injury and will support your needs. See a neuropsychologist for testing. Families and close friends need to be educated in brain injury and the thinking-related deficits that result from a rap on the head. Work together to recognize and gain control in order to prevent depression, which if left untreated may spiral downward and lead to more serious issues. The brain injured may need to take antidepressants if prescribed and never overlook the healing power of a healthy diet and exercise to keep the body … and mind … in shape.

This article was originally published by Sara E. Lewis at Suite101.com

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By understanding and recognizing the potential cognitive impairments of mild traumatic brain injury, we can identify them and obtain the appropriate therapy or treatment to lessen their impact.

Types of Mental Symptoms

Brain injury sufferers frequently exhibit any combination of these neuropsychological problems:

• Cognitive impairment – Reduction in intellect, memory, reasoning, math or language skills
• Behavioral issues – Anger, self-centeredness, aggressiveness, inappropriate behaviors
• Emotional problems – Depression, apathy, low self-esteem, social withdrawal, irritability

The patient with a serious brain injury may have many of these symptoms to a severe degree. Someone who otherwise seems to be fine after an accidental “bump on the head,” however, may have only a few of these symptoms.

Many of these symptoms are also commonly related to normal life stressors and to some physical diseases and mental disorders. This makes it even more difficult to accurately relate the symptoms to the cause in order to obtain the right treatment.

In a commonly recurring pattern, the mental symptoms of a brain injury appear within the week following the original injury, and most of the time the symptoms clear up within three to four weeks. In other cases, the symptoms may take 6 to 12 months to abate. When the symptoms persist longer than one year, they are frequently permanent, but often manageable with therapy.

Recognizing Cognitive Impairment

Slow Thinking

A subtle impairment clinically detectable only by comparative testing is a slow-down in thought processes. A study comparing the mental reaction times of injured and non-injured people with similar age and social background found the brain-injured patients lagged the control group measurably for several months following their injury. In the majority of cases, they caught up with their uninjured peers within three months without any specific treatment.

Memory Problems

Post-traumatic amnesia frequently occurs in association with a head injury. The patient does not remember events immediately preceding the injury, and often for a fixed period of time after the injury. Researchers are beginning to think that the overall duration of this amnesia is a far more significant indicator of residual mental deficits than the duration of unconsciousness following the injury.

Other types of memory problems also persist after injury. Difficulty in remembering objects (visual memory) is common in younger children, while difficulty in remembering words is frequent in adolescent children. These specific types of deficits are explained by the developmental stages of children’s brains.

Other problems associated with memory functions can include the inability to maintain short-term memory or the inability to store experiences in long-term memory. In an extreme case, a brain-injured man always greeted his wife with great enthusiasm as if he had not seen her in months, even if she had just left the room and returned moments later. More subtle memory issues can be difficult to diagnose as brain injury symptoms because memory can also be affected by psychological, pharmacological, and physical causes beyond brain injury.

Reduced Attention Span or Concentration

The inability to focus or concentrate on a task is frequently reported after a head injury; some cases may be due to the actual injury, while other cases may result from the psychological trauma following an accident. This symptom frequently resolves itself within weeks. When it persists longer, neuropsychological evaluation is called for.

A specific variation on this symptom is the inability to attend to more than one object at a time. An example is a printed paper form having many blanks to fill in that are simply overwhelming to the patient. Some patients can learn to mitigate this problem by covering the form with blank paper so that only one line item is visible at a time.

Another variation of this problem can be the inability to comprehend the contents of a closet. The contents appear as a unit and separate items are not intellectually distinguishable.

The following describes the emotional problems the TBI survivor can experience and some of the reasons they can be expected.

Irritability

Imagine having difficulty with memory tasks or concentration and being fatigued because you can’t sleep through the night. Imagine being unable to add two numbers in your head or looking in your refrigerator and being unable to make sense of its contents. Things that used to be easy are now incomprehensibly difficult. Do you think you would be irritable?

TBI survivors deal with such frustrations on a continual basis, but recent research has associated heightened irritability immediately after an injury with lesions on the brain’s left cortex. Those whose irritability appears some time after the injury are more likely suffering an emotional response to their diminished abilities.

Anxiety and Depression

Anxiety is unreasonable fear and apprehension that can lead to sleeplessness, restlessness, irritability, fatigue, and difficulty concentrating. Given that each of these by-products of anxiety is also a frequent brain injury symptom, it can make an accurate diagnosis of anxiety difficult. For someone coming to grips with what may be life-long disabilities, a certain amount of fear and apprehension about the future is probably not unreasonable.

When a person’s life and future have changed so dramatically, it seems predictable that the individual would become depressed. But depression can be so severe for many TBI victims that it leads to suicidal thoughts and actions.

Many discussions of emotional problems following a TBI list anxiety and depression together because it is not uncommon for the survivor to suffer both. But one small study found that a group of TBI sufferers with both anxiety and depression had lesions on one side of the brain, while another group experiencing clinical depression without anxiety had lesions on the opposite side. What does it mean? Researchers aren’t yet sure, but future data may reveal an organic basis contributing to both disorders.

Mood Swings

Also called “involuntary emotional expression disorder,” mood swings can have the patient literally laughing hysterically one moment and crying inconsolably the next. Angry outbursts over seemingly inconsequential matters may also be part of the package. The patient’s loss of control over emotional responses can strain the family and make social interaction difficult, causing the patient to withdraw and adding fuel to feelings of depression and anxiety.

Most experts agree this condition is a direct result of a brain malfunction because it also occurs frequently in association with Lou Gehrig’s disease, pseudobulbar palsy, stroke, and neurodegenerative diseases. This type of mood swing disorder is associated with frontal lobe injury.

Lack of Emotion

Lack of emotion is also described as apathy, lack of interest, lack of motivation, emotional numbness, or “flat personality effect.” The patient may have no interest in activities and have little response to sad or humorous situations. This condition is also associated with injury to the frontal lobe, which controls emotions and personality.

Behavioral Problems

Some rehabilitation experts make a slight distinction between emotional problems and behavioral problems; possibly because emotional issues affect the patient more severely while behavioral problems tend to have greater impact on people around the patient. Despite this difference in classification, the root causes can also be a mixture of organic injury and stress response.

Typical behavioral problems experienced by traumatic brain injury survivors include:

• Self-centeredness
• Aggression
• Inappropriate sexual behavior
• Extreme temper
• Cursing
• Manipulative behavior

Treatment for Emotional Problems

Treatment for emotional problems typically involves psychotherapy, behavioral therapy or rehabilitation, and/or medication. Each case is unique, and the patient’s physicians must develop an individualized treatment plan suited to the patient’s specific injury, symptoms, and tolerances.

Related Articles

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As comforting as that might sound to someone who’s suffered a head injury, it doesn’t really answer the questions “Was it just a concussion?” and “How can I be sure it’s not something worse?”

Was It Just a Concussion?

When the brain strikes the interior of the skull because of a blow to the head or a violent head movement, brain function is disrupted. Researchers are still trying to understand exactly what happens in a concussion, but current belief is that concussion symptoms can appear without any apparent physical damage to the brain.

Concussion symptoms are similar to the symptoms of many other diseases, injuries and psychological problems so there can be some risk of misdiagnosis by attributing the symptoms of some other illness to being the result of a minor head injury.

Nonetheless, doctors have a routine list of common symptoms that occur following a concussion. Not all of these symptoms occur, and the symptoms experienced may vary depending on the location and severity of the injury. Physical symptoms commonly appear soon afterward, while changes in mood or mental function may not be apparent until days later.

Physical Symptoms

• Loss of consciousness immediately following the injury
• Headache, nausea, or vomiting
• Dizziness, difficulty with balance
• Drowsiness or insomnia
• Weakness, fatigue
• Double or blurred vision, or sensitivity to light
• Ringing in the ears or decreased hearing ability
• Decreased ability to taste or smell

Cognitive (Mental) Symptoms

• No memory of events immediately before or after the injury
• Difficulty concentrating
• Repeatedly asking the same question
• Confusion
• Slow thinking
• Poor judgment
• Poor work performance

Emotional Symptoms

• Irritability, anxiety, or restlessness
• Depression
• Mood swings
• Decreased sex drive

How Can I Be Sure It’s Not Something Worse?

If you have any doubt as to the severity of the injury, see a doctor. Physicians will very likely rely on the Canadian Head CT Rule to evaluate whether a CT scan is advisable to diagnose a more serious traumatic brain injury. Following this rule, the doctor classifies the injured person as high risk, medium risk or low risk.

High Risk

• Low score on the Glasgow Coma Scale
• Evidence of an open, depressed or basilar skull fracture
• Vomiting more than twice
• Age over 65

Medium Risk

• Amnesia of longer than 30 minutes
• The injury occurred from a vehicle accident, being ejected from a vehicle, or a fall from a height greater than 3 feet

Those in the high and moderate risk categories get CT scans. Those not in the high or medium risk category are sent home with instructions to come back if symptoms change or worsen.

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