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