ABSTRACT
This book attempts to cover the assessment, identification, formulation, and psychological management of anxiety and mood disorders in persons with a history of traumatic brain injury. Perhaps, then, one of the fundamental questions in this book pertains to why practitioners need to be competent at performing a bedside mental status examination and cognitive screening. The simplistic answer here is that, within the context of a patient’s biological, social, and psychological history, this clinical assessment helps to identify the potential presence of a mood or anxiety disorder after traumatic brain injury. However, the diagnosis, while essential as a starting point, is only that: a starting point for providing a biopsychosocial formulation that endeavours to explain not only what the clinical presentation is, but also to explain why. For example, a person who has sustained a traumatic brain injury may present with a depressed mood because of a combination of factors. Some of these may include increased self-awareness (perhaps as a function of time since injury), loss of identity and role, inability to return to work (possibly in the context of pre-existing perfectionistic 206personality traits and current cognitive impairment), and pre-injury biological vulnerability (history) to depression. Clearly, formulation further explains or refines the diagnosis and, as such, is an integral part of the overall diagnostic process. It also highlights why history is so important. We cannot hope to formulate and understand our patients without knowing their pre-injury histories.
