Psychiatric aspects of head injury management

Acute damage to the brain may lead to many changes in a patient's behaviour and some of these behavioural changes will lead to the involvement of a psychiatrist. This article emphasizes that the usual clinical psychiatric approach is still appropriate, within the constraints of the situation. The specific skill needed is to analyze the behaviour in terms of all the potential causative factors. This is best done within the illness model derived from the World Health Organization's International Classification of Functioning (outlined in this article). In essence, one needs to establish whether the person has any 'hidden' specific neurological impairments, and to consider their context (physical, social and personal). The main fact to bear in mind is that brain injury is rarely the specific direct cause of irrational or unacceptable behaviour. The important influences are usually the environment, the person's pre-existing behavioural patterns, drugs (licit and illicit), and less commonly perceptual or cognitive losses. Management of difficult behaviour occurring in the early stages after brain damage is largely one of preserving safety through providing a suitable environment, including one-to-one care if needed while recovery occurs. Later it is likely that the brain injury is a specific factor, and management will be as it would be for anyone else presenting with similar problems. Time spent understanding why a behaviour arises will usually ensure the optimal management.