Interdisciplinary rehabilitation of a patient with right brain injury and recurrent depression

Abstract

Introduction

Rehabilitaton of concurrent psychiatric disorder and brain injury is a major challenge. E. underwent neurosurgery for right fronto-parietal astrocytoma. Before illness he was managing automatization of big companies, but was fired after the operation. E. felt into severe depression and anxiety with catastrofization of his illness, suicidal ideation. He resisted multiple prescriptions for SSRI, admitting a sect pretending to “treat” oncology by “psychological” methods. Half a year after operation he attended our center.

Objectives and aim

To help E. return to paid employment.

Methods

E. was evaluated by neurologists, psychiatrist, neuropsychologists. Current depressive episode appeared to be the second one with underlying schizoid and perfectionist characteristics. He had moderate text comprehension difficulties, confabulations, slight executive dysfunction. Neuropsychologist educated patient on his difficulties and developed compensatory strategies – an alternative to catastrofisation. After psychoeducational session E. agreed to receive fluvoxamine. However, he deformed the received information due to brain injury, so psychotherapy had only minor effects. Infra-low frequency neurofeedback at T4P4 and T4Fp2 sites was started to promote restoration of right brain functions. E. gradually did better, and 3 months later was able to complete CBT course along with relaxation training.

Results

Improvements in emotional status along with ability to cope with cognitive difficulties allowed E. to return to a job similar to the previous. Six month after the start of treatment medications are tapered off, E. has no signs of depression and only slight anxiety.

Conclusions

Interdisciplinary holistic rehabilitation may be effective in concurrent psychiatric disorder and brain injury.

Disclosure of interest

The authors have not supplied their declaration of competing interest.