Presenter: Angela McKeone, MS Therapist. March 18, 2016

Transcription

1 Presenter: Angela McKeone, MS Therapist March 18, 2016

2 TBI is a major cause of death and disability in the United States, contributing to about 30% of all injury deaths. Effects of TBI include impaired thinking or memory, movement, sensation (vision/hearing), and/or emotional functioning In 2010, about 2.5 million emergency department visits were associated with TBI

3 A TBI is caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. The severity of a TBI will range from Mild (such as a concussion) to Severe (memory loss after an injury or being unconscious for an extended period of time). Over a decade ( ) TBI-related ER visits increased 70% In that same time frame, sports-related injuries and recreational-related injuries increased 57% among children who were seen in the ER (ages 19 or younger).

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5 From , falls were the leading cause of TBI with more than 35% of these falls resulting in ER visits, hospitalization, or death. Unintentional blunt trauma (being hit by an object) was the second leading cause of TBI Motor vehicle crashes were the third leading cause, accounting for 17%

6 Compared to women, men have higher rates of TBI hospitalizations Rates for ER visits were highest among children ages 0-4 Falls were the leading cause of TBI-related hospitalizations for all except one group; assaults were the leading cause of TBI-related ER visits for people ages 15 to 24.

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9 In comparison to the general population, people with traumatic brain injury have a fourfold higher risk of death by suicide and a significantly higher lifetime prevalence rate of suicide attempts (8.1% vs. 1.9%) A study conducted by Simpson and Tate (2005) stated that respondents identified various antecedent circumstances to the attempts including depression/hopelessness, relationship breakdown, relationship conflict, social isolation, pressure of multiple stressors, instrumental difficulties (lack of finances, work difficulties), or more generally, the global impact of injury.

10 Survival analysis found an 18.4% probability of a suicide attempt occurring over the first 6 years post-injury. Clients with a post-injury history of psychiatric/emotional disturbance, substance dependence, or both were eight times more likely to a have a post-injury history of suicide attempts compared with clients with no history of these disorders.

11 The risk escalated for the smaller group with comorbid post-injury psychiatric/emotional and substance dependence disorders, who were 21 times more likely to have had a postinjury history of suicide attempts compared with the clients with no post-injury history of psychiatric/emotional disturbances or substance dependence

12 48.3% of clients who made an attempt postinjury went on to make at least one further attempt These percentages recommend that people who have made a suicide attempt post-tbi should be monitored closely for further signs of suicidality for at least 1 year after an initial attempt has occurred.

13 A review of interventions to prevent suicide found the strongest evidence for efficacy centered on limiting the availability of methods. Overdose is estimated at 62.5% followed by cutting at 17.5% as the principal means of attempting suicide. In order to reduce these risks it is advisable to remove guns and knives from the client and also lock up medication and have a caregiver administer medication as ordered.

14 With research regarding TBI and suicide still being so limited Simpson and Brenner (2011) indicated that focusing on veterans with a history of TBI will help to decrease suicide among this high-risk group and increase understanding regarding the relationship between neuropsychological functioning and suicide among the general population of veterans. Simpson s and Brenner s research canvas clinical, population, neurobiological, and treatment perspectives, with an emphasis in empirical research.

15 Brenner and colleagues found that veterans with TBI were 1.55 times more likely to die by suicide then the general veteran population, with the rate rising to 1.98 for those veterans who had sustained a concussion/cranial fracture.

16 Suicide-Related Communications Any interpersonal act of imparting, conveying, or transmitting thoughts, wishes, desires, or intent for which there is evidence (either explicit or implicit) that the act of communication is not itself a selfinflicted behavior or self-injurious. There is two subsets to suicide-related communications and they are suicide threat and suicide plan

17 Suicide-related behaviors can result in no injuries, injuries, or death. No injuries would relate to ideation in which the person took no physical action to harm oneself Self-harm is defined as self-inflicted, potentially injurious behavior for which there is evidence that the person did not intend to kill himself/herself. Suicide attempt is now defined as self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence of intent to die.

18 There is no one size fits all when it comes to treating TBI and suicidal behaviors. Everyone is different and much depends on pre-injury and post-injury emotional and/or psychiatric symptoms. The positive news is that there is a plethora of techniques to use and some new research showing even more ways to help.

19 Anchoring/Grounding An association between an emotional response and stimulus Re-pattern unwanted associations and responses Have the client hold an item and remind themselves they are in the present

20 Mindfulness Look out the window and observe what you see Feel the breeze on your arm paying attention to the temperature and sensation Smell a calming scent Feel an object in you purse or pocket

21 Simple Relaxation Strategies Breathing Awareness Deep Breathing Progressive Muscle Relaxation

22 Cognitive Behavioral Therapy CBT helps a person understand that thoughts, feelings, and actions all go together. Individuals with TBI suffer from PTSD related to the accident that caused the injury. Correcting cognitive distortions and reframing the accident/trauma can reduce suicidal thoughts. The goal is to improve client self-esteem and increase functionality.

23 CBT ~ Trauma-Focused CBT TF-CBT is mainly geared toward children In TF-CBT creating a trauma narrative is a key piece Trauma narratives can be created on a computer, with molding clay, poster board, anything creative TF-CBT assists the client with learning to change thoughts or beliefs about the trauma that are not correct or true

24 Dialectical Behavior Therapy DBT is a therapy designed to help people change patterns of behavior that are not helpful, such as selfharm, suicidal thinking, and substance abuse.

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26 Eye Movement Desensitization & Reprocessing was created by Francine Shapiro and is therapist-directed lateral eye movements (or hand-tapping or audio stimulation) which seems to have a direct effect on the way that the brain processes information.

27 EMDR therapy session wma&feature=player_embedded

28 Neurofeedback Neurofeedback is a type of biofeedback that measures brain waves to produce a signal that can be used as feedback to teach self-regulation of brain function. Neurofeedback is commonly provided using video or sound, with positive feedback for desired brain activity and negative feedback for brain activity that is undesirable

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31 TBI and Suicidality is something that is still under researched. I do believe that science is catching up to the need, but not as quickly as we would like to see. Understanding that there are options for care is why we attend these conferences. So network, communicate, exchange information, pick up and write down all that is here today. The change starts with each of us.

32 Centers for Disease Control and Prevention. (2015). Traumatic brain injury. Retrieved from November 4, Neurologic Rehabilitation Institute at Brookhaven Hospital. (2015). Depression and suicide among patients with traumatic brain injuries. Retrieved from October 24, Silverman, M.M., Berman, A.L., Sanddal, N., O Carroll, P.W., Joiner, T.E. (2007). Rebuilding the tower of babel: A revised nomenclature for the study of suicide and suicidal behaviors, Parts I and II. Suicide and Life Threatening Behavior, 37 (3): Simpson, G.K. and Brenner, L.A. (2011). Perspectives on suicide and traumatic brain injury. Journal of Head Trauma Rehabilitation, 26(4): Simpson G.K. and Tate, R. (2005). Clinical features of suicide attempts after traumatic brain injury. The Journal of Nervous and Mental Disease, 13(10):