A case report of guardian-consent forced paliperidone palmitate for behavioral disturbance due to traumatic brain injury

Psychosis After Mild Traumatic Brain Injury and the Role of an Integrated Brain Medicine Clinic

Psychosis after mild traumatic brain injury (TBI) can be rare, complex, and functionally impairing, often requiring inputs from various specialties. This usually entails separate visits and long wait times. We present the case of an elderly patient with schizophrenia-like psychosis after a mild TBI. Three years after the TBI, the treating physiatrist requested diagnostic clarifications and treatment recommendations from a brain medicine clinic (BMC), a novel integrated virtual clinic composed of neurology, psychiatry, and other brain-related disciplines. Six months later, the patient was overall improved, and her driver's license, which had been suspended 6 months after the TBI, was reinstated. We discuss diagnostic and treatment challenges of TBI. BMCs could provide timely, comprehensive, and efficient access to multispecialty care and resources for patients with complex brain disorders and minimize the artificial siloes in healthcare.

Treatment of Psychiatric Problems After Traumatic Brain Injury

Psychiatric sequelae of traumatic brain injury (TBI) can cause significant and often chronic impairment in functioning and quality of life; however, their phenomenological and mechanistic complexities continue to present significant treatment challenges. The clinical presentation is often an amalgam of syndromes and co-occurring symptoms that require a highly nuanced and systematic approach to treatment. Although few randomized controlled trials have tested treatments for psychiatric problems after TBI and the synthesis of results continues to be compromised by the heterogeneity of study populations, small samples, and differing inclusion criteria and outcome measures, an increasing body of literature supports evidence-based treatment strategies. We provide a narrative review of pharmacological, psychoeducational/behavioral, and neuromodulation treatments for psychiatric conditions in adults with TBI and discuss known or postulated mechanisms of action for these treatment approaches. Where data are available, we focus on randomized controlled trials and large case series in which a psychiatric condition provides both a selection criterion and a primary or secondary outcome. We conclude by proposing directions for future research, particularly the need for novel neuropharmacological, behavioral, and neurophysiological studies and pragmatic trials of multicomponent and adaptive models that will increase understanding of the mechanisms underlying post-TBI psychiatric disorders and accelerate dissemination and implementation of effective person-centered care.