Rationale

  • Acquired Brain Injury (ABI) leads frequently to multiple and long-term neuropsychiatric sequelae
  • Problems often appear months if not years after the initial injury
  • Patients surviving greater (extent and severity) neurosurgical injuries and illnesses (tumor, CVA, etc.) with much greater frequencies due to advancing neurosurgical knowledge and management
  • However, this leads to greater propensity of psychiatric morbidity to patient and to families / caregivers / community
  • Earlier identification and management of potential difficulties may lead to less psychiatric morbidity and intact families
  • Earlier identification and treatment of problem patients may also lead to less psychiatric morbidity in patient’s families (e.g. spouses, children, siblings, parents etc.)
  • Earlier identification will also enable better community integration and less institutionalization

 

Epidemiology

  • Incidence:                      120 per 100 000
  • New cases per year:       336 000
  • Deaths:                          28 000 (pre-hosp)
  • Severity:
    • Mild:           80% (154 000)
    • Moderate:   10% (92 000)
    • Severe:        10%  (61 600)         
  • Cost
    • age 0-4:       50 000/yr
    • age 5-14:     75 000/yr
    • age 15-24:   150 000/yr
    • age 24-44:   175 000/yr
    • age 45-64:   90 000/yr
    • age 65-74:   45 000/yr
    • age 75+ :      25 000/yr
  • Etiology
    • Alcohol:    40%
    • MVA:         40%
    • Falls:          15%
    • Violence:   10%
    • Sports:       15%
    • Others:       20%

 

Current perceived deficiencies

  • Patients are very well managed from a neurosurgical perspective
  • However, psychiatric issues in these patients are not usually considered unless very obvious or a placement issue
  • Premorbid subtle deficits or impact of injury or illness on a particular patient or their family / community is often overlooked
  • Patients are discharged and once medically stable are not seen in follow up
  • Patients not informed of possible and frequent psychiatric complications and thus when they occur months or years later, often catches patient and their family totally unaware and unprepared
  • This often leads to family breakup and patient isolation
  • Patients often unable to return to previous employment which worsens financial and emotional burden
  • Community supports are totally inadequate for the number of patients requiring services
  • Unless these patients are managed psychiatrically, community rehabilitation will fail. This is especially so in the more severely injured individuals

 

Suggested Solution

  • ABI is an identified target population that is under serviced
  • See patients through a specialized ABI Clinic


Benefits

  • Be better able to do consultations within a reasonable time frame form initial referral
  • Provide ongoing follow-up, cognitive behavioral management and individual psychotherapy / counseling as required
  • Provide assistance to enable patients to live independently in the community
  • Keep patients within the family and community mileau
  • Keep families intact
  • Continuum of care from young, medically stable behaviorally difficult ABI patients to older, more fragile, medically unstable, behaviorally difficult demented  ABI patients