The person’s medical history may have an impact upon their clinical presentation following brain injury. For example, a history of conditions associated with pain, discomfort and/or fatigue may have an impact on the person’s presentation and potentially affect their ability to cooperate with treatment, care and support. This may be related to the person being unable to appropriately express their experience of pain and distress. The person may potentially present with high levels of anxiety, agitation and occasionally aggression.
In the context of untreated, pre-existing dental problems, the person may experience high levels of pain which may go unrecognised by care professionals.
Please note that, in the context of significant cognitive/communicative problems, the person may not be able to identify pain, discomfort or high levels of fatigue as the source of their agitation/distress and may even actively deny being in pain etc. Treatment of the problem can have a very positive outcome and lead to a reduction in challenging behaviour.
Pre-existing mental health issues (e.g. depression, anxiety, obsessive compulsive disorder, bipolar disorder, psychosis) will have a significant impact on the person’s mental state and behaviour following brain injury. During the early stages of recovery, treatment for a pre-existing psychiatric illness may sometimes be omitted because other physical health issues take priority. This may subsequently lead to a significant deterioration in the person’s mental state, behaviour and general level of functioning. The person’s potential to benefit from rehabilitation will be limited until appropriate treatment is reinstituted.
It is important to be aware that a pre-existing psychiatric illness may not have been recognised prior to the brain injury but may become a prominent feature subsequently. A careful and detailed history from family members and close acquaintances may yield helpful information.
A pre-existing psychiatric illness increases the risk of sustaining a brain injury e.g. accidental or intentional overdose, self hanging attempt, accidental or intentional trauma, self-injurious behaviour.