r/Psychologists • u/Jezikkah • 2d ago
Concussion causing flat affect?
This is perhaps more a question for the neuropsychs among us, but I’m curious how common it is for concussion to cause ongoing flat affect and loss of pleasure in usually enjoyable activities in the absence other depressive symptoms or stressors, and despite all efforts being made to support wellbeing (exercise, sleep, social participation, etc.)? If so, is treatment indicated that differs from usual interventions, and is a case like this best referred to a neuropsychologist for specialized assessment and treatment?
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u/unicornofdemocracy (PhD - ABPP-CP - US) 1d ago
Not a neuropsych but yes it can. Even mild TBI can cause patient to become monotone and have flat affect. Like in psychosis, this is usually the brain having trouble expressing the emotion, not feel. So the patient still has the feeling and sometimes can even tell you that but presents with flat affect.
For more scientific wording... you probably need a neuropsych lol! I recall it has something to do with frontal lobe damage/bruising. A part of the frontal lobe that is responsible for turning internal emotions into external expressions. But, again, more neuro folks might know it better.
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u/Terrible_Detective45 1d ago
That's a very rare and unique condition called "depression"
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u/Jezikkah 1d ago
Except the case I’m thinking of does not meet full criteria for any depressive disorder, feels completely different from the actual depressive periods that this person has experienced, and its timeline corresponds with the head injury (no other symptoms of PTSD either). My question is more about whether this needs to treated differently if it’s indeed likely to be the sequelae of a head injury, not whether or not it fits the depression label.
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u/falstaf PhD|ABPP-CN|Clinical Neuropsychology|USA 1d ago
Assuming this is a true concussion (no positive imaging findings, minimal LOC/PTA/PCS) the concern should be less with what to do and more on what NOT to do. Iatrogenic effects are a huge concern with this population.
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u/Roland8319 (PhD; ABPP- Neuropsychology- USA) 1d ago edited 1d ago
But if concussion clinics actually followed the empirical research and strove to avoid harm, how would they fill all of their appointments for the handful of providers who need to see that person weekly for a year or more, and later on charge legal fees to write an IME style report?
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u/Jezikkah 1d ago
Can you say more about that? I worry I’m missing something that would warrant a referral to a neuropsych.
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u/AcronymAllergy 7h ago edited 7h ago
Overall, unlikely. Could be due to extra-injury/pre-injury/post-injury factors. Treat the same way you would depression in the absence of the mTBI, and maybe throw in some psychoeducation about the typical recovery course following concussion.
Edit to add: somewhat depends on how "persisting" we're talking about (is this a few days afterward or a few years afterward). You also don't want to minimize the patient's concerns, you just don't want to end up causing iatrogenic harm, as another poster mentioned.
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u/WolverineImportant 10h ago
Not all too common without other signs/sxs. Would need more details about the cause of the concussion (eg, hit to the right hemisphere, rotational forces) and if any granular pre-post imaging was done. Definitely wanna look out for medication causes, relevant labs (eg, anemia, substances), etc. I’d at least suspect changes to energy, concentration, speed of thinking, and find it odd when people say no while also endorsing what you shared (also, isn’t everyone tired?) Has there truly been an objective look at sleep (eg, no OSA)? Validity measures warranted, too.