MTBI and PTSD
PTSD and MTBI co-morbidities
At NL we are focused on the prosecution of complex medical matters, particularly traumatic brain injuries, including mild traumatic brain injuries. We have written before about the challenges in these prosecutions, but this blog will address the complexities of concomitant psychiatric diagnoses, specifically Post-traumatic Stress Disorder.
Most people don’t realize the role statistics plays in health care. Nowhere is this more clear than in the diagnosis of psychiatric conditions. The most recent iteration of the book used to make proper diagnoses is called the Diagnostic Statistical Manual version five (DSMV). In simple terms, the book lists combinations of symptoms and time periods that if, when presented in certain combinations, make the presence of a condition statistically likely. Statistics also play a role in diagnosing mild traumatic brain injury through the use of neuropsychological testing and even sophisticated Diffuse Sensor Imaging MRIs.
In a recent prosecution, a physically fit athlete with a long history of military and law enforcement service was riding a bicycle for exercise when a car disobeyed the rules of the road and struck him. He sustained physical injuries and corresponding psychiatric ones, namely Port Traumatic Stress Disorder (PTSD), although without a mild traumatic brain injury component. Post Traumatic Stress Disorder naturally plays into a defense of denial of responsibility, since the criteria for meeting the diagnosis are not met until at least 6 months after the event. This delay in diagnosis and treatment allows for a natural defense of “what took so long,” or “how could our accident have caused this,” “or why isn’t it in the ER or the first 5 months of treatment records?” These, coincidentally, are the same defenses we see over and over in mild traumatic brain injury cases.
According to the National Institute for Mental Health, and the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD as some point in their lives. Obviously not all will involve a mild traumatic brain injury. But all will involve the elements of Trauma and Stress.
It is important to recognize that risk factors for PTSD include: living though dangerous events and traumas, getting hurt, seeing another person hurt or seeing a dead body, having little or no support after the event, dealing with extra stress after the event such as pain and injury, or loss of a job or home. Many of these factors are present in mild traumatic brain injuries as well.
In the newest version of the DSM, number five, PTSD was removed from the anxiety disorders section and placed into a newly created section called Trauma and Stress Related Disorders. It is our hope at NL that the psychiatric focus on PTSD will help label this debilitating condition that often accompanies mild traumatic brain injuries and that patients will be more likely to get the care and treatment they need.
In a recent NL Team prosecution, a physically fit athlete with a long history of military and law enforcement service was riding a bicycle for exercise when a car disobeyed the rules of the road and struck him. He sustained physical injuries and corresponding psychiatric ones, namely Port Traumatic Stress Disorder (PTSD), although without a mild traumatic brain injury component. Post Traumatic Stress Disorder naturally plays into a defense of denial of responsibility, since the criteria for meeting the diagnosis are not met until at least 6 months after the event. This delay in diagnosis and treatment allows for a natural defense of “what took so long,” or “how could our accident have caused this,” “or why isn’t it in the ER or the first 5 months of treatment records?” These, coincidentally, are the same defenses we see over and over in mild traumatic brain injury cases.
According to the National Institute for Mental Health, and the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD as some point in their lives. Obviously not all will involve a mild traumatic brain injury. But all will involve the elements of Trauma and Stress.
It is important to recognize that risk factors for PTSD include: living though dangerous events and traumas, getting hurt, seeing another person hurt or seeing a dead body, having little or no support after the event, dealing with extra stress after the event such as pain and injury, or loss of a job or home. Many of these factors are present in mild traumatic brain injuries as well.
In the newest version of the DSM, PTSD was removed from the anxiety disorders section and placed into a newly created section called Trauma and Stress Related Disorders. It is our hope at NL that the psychiatric focus on PTSD will help label this debilitating condition that often accompanies mild traumatic brain injuries and that patients will be more likely to get the care and treatment they need.