Welcome to the TBI-HELP Live Chat

Today's topic is: "Psychoactive Medications in Traumatic Brain Injury"

Our Guest is: Dr. Rajesh Desai, Neuro-psychiatrist from Queens-Nassau Nursing Facility

[18:56:46] mod: Welcome to our chat this evening. It is our pleasure to have with us Dr. Rajesh Desai from Queens-Nassau Rehabilitation and Nursing Center. Welcome to Dr. Desai!
[18:57:33] Dr.Desai: Thank you very much and I'm happy to be here..
[18:57:56] mod: Rail: What are some of the more common psychoactive drugs - and why are they prescribed in TBI?..
[18:59:42] Dr.Desai: Psychoactive generally means any medication that changes thinking, feeling, mood and or behavior. Most common are antidepressant like prozac zoloft, paxil, celexa.. The next group of medications are antipsychotics used to reduce or eliminate hallucinations, delusions, agitation and aggression. Next group are mood stabilizers ie. depakote, neurontin, tegretol, etc. This group stabilizers mood, and reduces aggression and agitation. This group is also is used for seizures and thus serves dual function.. Next group is antianxiety ie. valium, ativan, zanax etc. as the name indicates it is used to reduce anxiety.. This last common group is central nervous system stimulants. ie. ritalin. this is used in coma emergents to increase patient's arousal level..
[19:04:24] mod: When a doctor recommends some of these medications, what questions should I ask?..
[19:07:32] Dr.Desai: 1) Name of the medication, 2) Dose, 3) Why is it necessary, 4) How would it help in rehab, 5) Would it increase chance of seizures..
[19:09:12] mod: Susan: How does ritalin help in a comatose person? I know it is sometimes used with the hope of arousing the consciousness?..
[19:10:13] Dr.Desai: Ritalin is not used for coma recovery but it is used to increase arousal level of a patient so that he or she can be available staff for longer period..
[19:11:23] mod: Susan: Which type would best be used to maximize abilities with a minimum of side effects but to help control impulses and create more calmness?..
[19:14:41] Dr.Desai: All psychoactive medications have side effects for example sedation , drowsiness lethargy, Side effects are also function of the dosage level. Most common and effective medications to produce calmness and control impulses without much side effects are mood stabilizers.. 
[19:15:54] mod: What is your opinion about over-the-counter supplements such as "ginkoba" in treating mood disorders post - TBI?..
[19:17:55] Dr.Desai: Prior to starting such medication please inform your physician so that he can check for drug interactions. Over the counter medications like "ginkoba" also has harmful interaction with many drugs. No significant study has shown any benefit..
[19:16:35] mod: Please remember that these are the opinions of Dr. Desai and to always check with your own doctor. Thank you.
[19:20:32] mod: Susan: Some drugs have a 1/2 life, I think thats what is called and thus make you groggy as they wear off. Wouldn't that be adverse for someone who may already be confused due to TBI?..
[19:22:22] Dr.De: All drugs have half life. All it means that 50% of the drug is eliminated from the body during the half life. So, if a drug has a 12 hour half life than 50% of the drug is eliminated in 12 hours. Which means you would be less groggy as the drug wears off.. Use of this medication is a delicate balancing act in order to reduce symptoms which diminishes ability of the patient to partici[ate in rehab. with least amount of side effects. Also one wants to use medication that enhances ability of the resident to participate in rehab. for example antidepressants..
[19:26:05] mod: Rail: What side-effects would be triggers for asking to discontinue the medications?..
[19:29:11] Dr.Desai: Any side effects that diminishes resident's capacity to participate in rehab. will fall under this and medication should be tapered rather than stopped completely. For example antipsychotic gives tremors and spasticity which interferes with PT and OT..
[19:31:20] mod: Rail: What about possibility of addition with these medications?
[19:33:25] Dr.Desai: Only psychoactives that truly may be addicting are antianxiety medication such as valium, ativan, xanax . When these medications are administered by staff and/or family as prescribed chance of addiction would be truly very rare.. ,
[19:34:26] mod: Moory: What are some of the newer medications that have been found to be helpful in treating these patients?..
[19:36:16] Dr.Desai: Newer medications like zyprexa, celexa, trileptal are being used for tbi, the advantage of most newer medication is much less chances of side effects..

[19:35:30] mod: Once again, please remember to always check with your own doctor on any issues you may have. Thank you.

[19:37:16] mod: Susan: What type is klonopin? I know it is used for spasticity but is also very sedating and a bad choice that teens were using to get high...
[19:38:48] Dr.Desai: Klonopin is an antianxiety agent used for reducing anxiety, spasticity and also used in seizure disorders. Used in lower dosage should not produce much sedation, yes it can be addicting if not used properly..
[19:39:10] mod: Lamont: What are the effects of some of the newer SSRI's in the treatment of these patients?..
[19:39:35] mod: Lamont: What type of support groups do you provide for the caregivers?
[19:40:42] Dr.Desai: Newer SSRI especially celexa is used extensively and is faster than other SSRI's in response time. It also has less side effects..
[19:41:25] Dr.Desai: We at Queens Nassau have weekly support groups for caregivers and usually have one expert from tbi staff to educate them..  All meetings between staff and caregivers are encouraged and we have used families with rehab staff acting as assistants so they can understand and continue therapy at home..
[19:43:00] mod: Susan: What's an SSRI?..
[19:43:53] Dr.Desai: Selective serotonin uptake inhibitor, this is abbreviation of its mechanism in the brain..
[19:44:51] mod: If more then one psychoactive is being used, would it not produce more side effects?..
[19:46:31] Dr.Desai: If two medication are used and both have the same mechanism of action in the brain, then the chances for more cumulative side-effects are present. Usually prescribing physician take this into account while choosing dosage of each medication..
[19:47:20] mod: Do I, as guardian of patient have right to refuse medications?..
[19:48:43] Dr.Desai: Yes, only if the TBI patient is judged to be incompetent for consent for treatment.. Guardian does not have the right to refuse treatment in case of emergency when there is imminent danger to the patient of to others..
[19:52:08] mod: How to cope with TBI survivors difficult behaviors at home?..
[19:53:26] Dr.Desai: There is no right or wrong way, it's what works that makes it right. Observe some of the following principles..
[19:53:47] Dr.Desai: 1-Structure daily routine 2 - avoid surprises..
[19:54:27] Dr.Desai: 3 - Prepare patient for departure from daily routine - 4- Look for triggers that start problem behavior and avoid them if you can..
[19:54:49] Dr.Desai: 5- Distract patient into different activity..
[19:55:34] Dr.Desai: 6 - Use techniques that usually calms the patient ie music, t.v. walk outside the home, favorite food or drink..
[19:55:49] Dr.Desai: 7 - Reward positive behavior and ignore behavior as long as it is not dangerous..
[19:56:00] mod: Al: How do you become a guardian?..
[19:57:20] Dr.Desai: Guardianship is usually a legal procedure however, physicians, hospitals, usually accept next of kin as guardian for treatment purposes as long as there are no conflicting claims by different family members..
[20:01:06] mod: Well, I see that our time is up for this evening. I want to thank Dr. Desai and company for a wonderful chat session and I invite them to return in the future. Thank you all for your great questions, good night and be safe!
[20:02:13] Dr.Desai: It has been a pleasure to chat with all of you and I would participate in this chat in the future..