Major depressive disorder (MDD) is the most prevalent psychiatric disorder in people with traumatic brain injuries. Cognitive Behavoural Therapy (CBT) is a talking therapy which can help people who are experiencing a wide range of mental health issues. What people think can affect how they feel and how they behave.

During times of mental distress, people think differently about themselves and what happens to them. Thoughts can become invasive and extreme, and are not helpful to the recovery of the patient. This can worsen how they feel. This may then cause them to behave in a way that prolongs their distress.

Clients and therapists work together to identify and understand problems in terms of the relationship between thoughts feelings and behaviour. This then leads to identification of personalised, usually time-limited therapy setting goals and strategies which are continually monitored and evaluated. The client learns to harness their own resources, and the treatments are inherently empowering in nature. I t is also carried on beyond the structured time of the therapy session, and the client is encouraged to put these empowering changes into practise between sessions (“homework”.)

the therapist uses approaches which can be used to help anyone irrespective of ability, culture race or gender or sexual preference. Cognitive and behavioural psychotherapy can be used on it's own, or in conjunction with medication. This is dependant on the severity and nature of the symptoms the brain injured client exhibits.

Brain Swelling After Injury

Brain swelling after trauma is unavoidable, and is the end result of the many different kinds of injury to the brain. The other medical terminology for this swelling is called oedema,where the injured brain bleeds and may swell.

As the skull itself is a hard rigid structure, the brain presses harder and harder against the rigid skull, which causes dysfunction of the nerve cells. This may develop from a slight oedematous change to a worst case scenario, where, the brain itself begins to herniate down to the brain stem at the top of the spinal column.

The brain stem controls the body's vital functions, so when the pressure builds

it, it has a detrimental effect at the back of the brain. The respiratory centre located here

will mal-function, causing the person to stop breathing, go into cardiac arrest, lose

consciousness, and if the herniation goes unchecked, die.

The first symptoms of increased pressure within the skull, include worsening headache, impaired thinking, decreased level of consciousness, and vomiting. Later the person may become unresponsive with both or one of their pupils widening.

Hospital admittance is necessary and X-Rays and CT and MRI scans may well be given to aid diagnosis. The medical staff must ensure that blood pressure and levels of oxygen and carbon dioxide in the blood are kept at desirable levels. Intravenous therapy is given, but carefully monitored, and diuretics such as furosemide and mannitol administered.

If seizures occur, anticonvulsants are given. A small pressure gauge may be implanted inside the skull to measure pressure build-up within the skull. This will also determine how well the treatments are preventing or treating the pressure elevation within the brain.

A catheter can be placed in the small space or ventricle which lie in the brain. The ventricle contains cerebrospinal fluid, which flows over the surface of the brain between the layers called the meninges. Any excess fluid can be drained off to reduce pressure.

Sometimes the surgeon will surgically open the skull to relieve the pressure and remove any blood and clots.

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