Welcome to the TBI-HELP Live Chat

Today's topic is: "Mood and Behavioral Changes post Traumatic Brain Injury"

Our Guest is: Judy Hayman, Ph.D. Psychologist, Outpatient Rehabilitation Medicine, Jamaica Hospital Medical Center

[18:56:45] mod: Good Evening everyone and welcome to our professional chat session. Tonight it is our pleasure to have with us Dr. Judy Hayman
[18:57:43] mod: Dr. Hayman is a Psychologist in the Outpatient Rehabilitation area of Jamaica Hospital Medical Center
[18:58:10] mod: and will be discussing Mood and Behavioral Changes Post TBI
[18:58:18] mod: Welcome Dr. Hayman
[18:58:38] Dr.H: Thank you. Good evening everyone.
[19:02:05] mod: Since our topic this evening is Mood and Behavior can you please explain what types of mood changes can occur post-TBI?
[19:02:44] Dr.H: Commonly experienced mood/behavioral changes post-TBI include depression, anxiety, anger, irritability, low frustration tolerance, difficulty controlling one's emotions, and substance use.
[19:03:33] mod: How often do mood changes-significantly post trauma-indicate improvement in the patient?
[19:04:08] Dr.H: That would probably depend on a lot of factors including what type of mood changes and the period of time that has passed since the trauma. Do you have a specific example or a specific mood change in mind?
[19:05:10] mod: What do you mean type of mood changes?
[19:06:10] Dr.H: Since the question was how often do mood changes indicate improvement, I was wondering if the person who asked the question had a specific mood change in mind.
[19:07:02] Dr.H: Were they talking about an improvement in mood, a decline in mood, etc.?
[19:07:04] mod: Amanda: As time passes the behavior and moods seem to change Old ones disappear and new ones take their place. Not because of behavior mod teaches they may not be appropriate but it seems more like emotional growth. Maybe a way of showing that there is an understanding of why an action is done.
[19:08:06] Dr.H: That is certainly possible. Recovery post-TBI often includes changes in behavior and emotional growth.
[19:09:35] mod: I would assume that a change from tacit compliance to a more inactive mood would indicate positive progress- but how much can change actually indicate how the patient is doing, and if it is an improved state
[19:12:39] Dr.H: Acting out is one possible behavior of someone who is severely cognitively disabled and has no other means to communicate.
[19:13:16] Dr.H: You're right, often it falls on the caregiver to try and determine what the person is trying to communicate.
[19:13:17] mod: Amanda: A person who is severely cog. disabled will act out instead of using words, because they might not be able to. It seems like its our job at caregiver to guess by trial and error or really in to see the cause.
[19:15:49] mod: Beth: I would assume that post-TBI rehabilitation counseling would be helpful to process feelings of anger and guilt? I'm not sure of the correlation of people with newly acquired TBI and and suicide but I would suspect that it is high?
[19:16:13] Dr.H: Counseling is very helpful to process feelings of anger & guilt & may provide the only outlet/resource a person has to express those feelings.
[19:16:46] Dr.H: It's often difficult for family members & other caregivers to deal with negative emotions following TBI.
[19:18:08] Dr.H: Beth, I don't know what the correlation is between those with a newly acquired TBI & suicide, but people often report wishing that they had not survived their energy. Risk for suicide is assessed both inpatient and outpatient & if you feel that someone you know is experiencing suicidal thoughts, you should assist them in seeking professional help with someone who is experienced with TBI.
[19:19:22] mod: Charles: Why is it that sometimes my relative can be so calm and suddenly there is an outburst...what causes that?
[19:20:56] Dr.H: Outbursts are one of the common behavioral changes seen post-TBI. This can occur for many reasons including frustration, fatigue, change in a person's level of awareness.
[19:21:35] Dr.H: Also, depending upon the area of the brain involved, behavior dyscontrol is a common problem post-TBI.
[19:21:56] mod: Jimmy: How can you get a post TBI patient to counseling if they are s unpredictable with their behavior?
[19:22:37] Dr.H: Jimmy, you can talk to them about your concerns & some of the changes you have noticed. You could ask them to go with you to talk about problems they may be experiencing. Support groups are another source of help for post-TBI patients & their families & maybe they would be willing to go to a support group with you.
[19:23:55] mod: Beth: Having never had much contact with people with TBI, can I expect that mood/behavior changes such as depression, aggression are long-term or a reaction to the injury? My family member is verbal.
[19:24:37] Dr.H: Depression is a common emotional change post-TBI & can occur after a long period of time has passed. Aggression can occur both as a result of the injury, or in reaction to the injury, or during the process of adjusting to the disability.
[19:26:49] mod: Jimmy: Sometimes that works because they understand but other times they don't...it's very confusing...any strategies I could use?
[19:27:44] Dr.H: Jimmy, I'm not sure what you're referring to by saying sometimes that works, could you please clarify?
[19:27:45] mod: Jimmy: Talking about depression, are there any new meds that are successful in this area for TBI Patients?
[19:29:27] mod: Amanda: It does seem reasonable that someone with a TBI would be depressed. There life as they know it has changed, in some cases drastically. How can the family help?
[19:32:14] Dr.H: Amanda, family members can help by trying to provide as much support and understanding as they can. They can also refer their family member to a professional if it seems like they are experiencing significant distress.
[19:32:55] mod: Do moods and behavioral changes affect everyone with a TBI
[19:33:30] Dr.H: The changes which can occur typically affects each individual differently. There are many factors involved including the location & severity of the injury, the time that has passed since the injury, & the extent the person has been able to resume prior activities.
[19:34:37] mod: Bill: The stress of caring for our child has really begun to wear our family out...any suggestions as how we can better cope with the stress?
[19:34:59] Dr.H: Bill, that's a very good question!
[19:35:26] Dr.H: It's very important for family members to be aware of the possibility of increassed stress. Support groups for family members are one good way of coping. There is a section on the website for caregivers which discusses other options including relaxation technioques. Finally, it's important tha family members resume their activities too & take time to do things they enjoy.
[19:36:54] mod: Bill: Would some type of psychological testing help us to understand our relatives behavior better?
[19:37:34] Dr.H: Bill, psychological testing & neuropsychological testing are both important following TBI. Testing helps to identify a person's strengths & weaknesses which assits in treatment planning. So yes, testing is a good idea, psrticularly if ther person has not been evaluated post-TBI.
[19:38:31] mod: Rail: I know that Respite care is available but scarce - Are there any tips from the professionals that come into give the family some rest that may actually be key coping strategies to lower the stress?
[19:39:41] Dr.H: Rail, some of the things I just mentioned would help to reduce stress. Another possibility is that the family member may want to seek professional help to deal with adjustment to the disability of their relative or loved one. I believe some states have services in home available. I'm aware of in home services in NJ, but don't know about NY.
[19:40:55] mod: Bill: Do behaviors that didn't exist before sometimes appear as a result of a TBI...lwhat I mean is suddenly our relative has begun to drink why is that?
[19:41:32] Dr.H: Bill, yes. Behaviors that existed before often return post-TBI. In fact, substance use is a common change post-TBI. It may be a means for the person to cope with all the changes they are experiencing.
[19:42:10] mod: Bill: Does anyone come to your home to do counseling, an is that available?
[19:42:43] Dr.H: Bill, in some cases there are professionals who come to that house. Advisability would probably depend on whether the person is able to leave the house. If they can leave, they probably would not be eligible to receive in-home services.
[19:45:21] mod: Rail: Do some of the Tests evaluate for relative mental age independent from physical/ability age? That way, if the cognitive component can understand the caregiver can give a realistic guide to the patient Okay the accident has given you the walking of a 3 year old - so give yourself a chance!
[19:45:36] Dr.H: Rail, tests can provide that kind of information. Typically what is of interest is the person current abilities, & treatment is targeted to the person's ability/capability.
[19:46:13] mod: Given the "dis-abiity" issues with TBI, how easy is it to arrange transport services for a marginally ambulatory patient?
[19:46:38] Dr.H: Rail, services are fairly easy to arrange, dependent upon the type of insurance a person has.
[19:47:15] mod: Amanda: What would you say if the person never gets depressed, always happy and really to disabled to fully understand their condition. Can they still be depressed nd we not know it? That sounds weird but its the best way to explain it
[19:47:32] Dr.H: Amanda, it's possible that they could be depressed. It's also possible that the person has good coping strategies and a good support system, & is adjusting to changes post-TBI.
[19:48:32] mod: What should someone do if they are experiencing mod/emotional changes or behavioral problems?
[19:49:01] Dr.H: They should seek professional help with someone who has experience working with TBI. Frequently, this would be a psychologist or a neuropsychologist.
[19:49:07] mod: Amanda: That's a positive outlook!
[19:49:56] Dr.H: Amanda, it's difficult to say if someone is depressed without much more information, including a personal interview. If you think they may be depressed, you should refer them for a professional evaluation.
[19:50:19] mod: What kind of treatment is available?
[19:51:19] Dr.H: There are many treatment options available including individual, group, couples, or family psychotherapy, support groups, behavioral management/modification & medication.
[19:51:48] mod: Why do changes occur in the person's moods?
[19:52:29] Dr.H: The regulation & production of emotion is a complex, integrated, interconnected system which takes place within many areas of the brain. Changes or disruptions at any level can result in emotional changes. Changes may also occur in reaction to or during the course of adjustment to a person's disability following a TBI.
[19:53:22] mod: Bill: How can you go about getting a professional evaluation at the place that works with these patients?
[19:54:50] Dr.H: Bill, usually you need a referral from a physician, but you could contact sites that work with TBI patients to request more information.
[19:54:50] mod: Bill: Do the groups cost money or are they free or covered by some ins.?
[19:55:18] Dr.H: Bill, there are many free support groups available in the NY area. Check the website for a listing. Also, insurance does cover some group therapy, again depending upon the insurance,
[19:55:43] mod: Rail: Is there a sequence of moods that indicates a constructive acceptance of the TBI situation - or is each case totally unique in this regard?
[19:56:27] Dr.H: Rail, there is really no sequence of moods for every person, so yes, each individual is unique.
[19:57:48] Dr.H: Bill, there is a support group for family members/parents of a TBI child. Check the website for the listing.
[19:59:09] mod: Amanda: Can't sudden changes indicate something is going wrong in the brain?
[19:59:32] Dr.H: Amanda, that is one possibility. It depends upon what type of changes you're referring to. It may also be a reaction to increased awareness, or a result of increased frustration, or other factors.
[20:00:39] mod: I want to thank Dr. Hayman for a wonderful discussion this evening and I welcome her back to chat with us in the future. Good Night until next week.
[20:01:09] Dr.H: It was a pleasure! Thank you for inviting me to participate. I'd love to return in the future.