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People with anxiety or PTSD following a

traumatic brain injury are more likely to be
prescribed medication than attend
psychotherapy
by Beth Ellwood — November 17, 2022 in Anxiety

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A team of researchers explored treatment patterns among people

  Psychopathic tendencies are
diagnosed with anxiety or PTSD following a traumatic brain injury. The
associated with an elevated interest in
findings, published in the Journal of Neuropsychiatry and Clinical fire, study finds
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Neurosciences, revealed that these individuals are more likely to be
prescribed psychotropic medication than to receive psychotherapy —  New psychology research rebuts
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Sigmund Freud’s “wrecked by
which may be a cause for concern.
success” hypothesis
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A traumatic brain injury (TBI) is a sudden injury to the brain that results in
 Attractive female students no longer
 neural damage. This brain damage can manifest in symptoms of mental earned higher grades when classes
health disorders like anxiety and depression. But such mental health moved online during COVID-19
 issues frequently go unnoticed, despite their poor effect on TBI recovery.
 Web-based exercise intervention leads
to mental health improvements in 3
 months, according to controlled trial

  New psychology research reveals

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Research into anxiety disorders and PTSD following a TBI has been
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particularly limited, and there are few evidence-based recommendations
for treating these populations. Accordingly, Marks and her colleagues  Study links identity threat among white
sought to investigate the treatment patterns of people diagnosed with evangelicals to the belief Trump’s
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either of these disorders following a TBI. Specifically, the study authors
assessed the use of psychotropic medication and psychotherapy.

“Anxiety and PTSD following TBI are common sequelae that impede
recovery, but evidence-based treatment guidelines are lacking. As a
clinician, I am interested in identifying treatment gaps to enhance access
to care,” said study author Madeline R. Marks, an assistant professor at
the University of Maryland School of Medicine.

The researchers obtained deidentified insurance claims data from the

OptumLabs Data Warehouse (OLDW). The data set included longitudinal
health information pertaining to a diverse set of enrollees across the
United States. For their study, the researchers focused on enrollees who
were above 18 years old and had been diagnosed with a traumatic brain
injury sometime between January 2009 and June 2012. The authors
further restricted the sample to people who were enrolled with medical
and pharmacy benefits for at least one year prior to the TBI and two years
after — leaving a sample of 207,354 individuals.

Within this sample, the researchers identified enrollees who had been
diagnosed with an anxiety disorder (42,475) or PTSD (1,232). With the
help of an expert panel, they then analyzed the data and identified receipt
of psychotherapy, as well as any prescriptions for medications used to
treat anxiety and PTSD.

In line with U.S. trends, use of medication was much more common than
psychotherapy. For the group with an anxiety disorder diagnosis, 76.2%
received pharmacological treatment at least once post-TBI, but only
19.1% received psychotherapy treatment at least once post-TBI. For the
group with a PTSD diagnosis, 75.2% received pharmacological treatment RECENT

post-TBI, while only 36% received psychotherapy following TBI.

 People with anxiety or PTSD following
a traumatic brain injury are more likely
to be prescribed medication than
attend psychotherapy

Among both groups, antidepressants were the most commonly prescribed  Regular exercise leads to improved
performance on cognitive tests in
class of psychotropic drugs. Interestingly, the anxiety disorder group was
overweight children
more likely to be prescribed antidepressants (51%) than the PTSD group
(39.3%), although the two groups exhibited similar rates of depression.  New psychology research rebuts
Sigmund Freud’s “wrecked by
The next most commonly prescribed drug class for the anxiety group was success” hypothesis

intermediate-acting benzodiazepines (19.1%). The authors say this is

 Psychopathic tendencies are
cause for concern since these drugs are no longer viewed as first-line associated with an elevated interest in
treatments for anxiety and are even strongly discouraged in patients post- fire, study finds
TBI due to concerns over side effects and addictive properties.
 Web-based exercise intervention leads
to mental health improvements in 3
Participants with PTSD consulted psychotherapy at twice the rate of those
months, according to controlled trial
with an anxiety disorder. But this number was nonetheless low, with the
 PTSD group still being more likely to receive medication than
psychotherapy. This is also of concern, the researchers say, since
psychotherapy is regarded as a first-line treatment for both PTSD and
anxiety disorders and one that does not carry the risk of unfavorable
medication interactions.

“Treatment patterns for anxiety and PTSD that we observed post-TBI do

not align well with current recommendations,” Marks told PsyPost. “For
example, psychotherapy is considered first-line treatment for PTSD, yet
our results suggested that among individuals with TBI, pharmacotherapy
is more often utilized. Similarly, benzodiazepines were commonly
prescribed to individuals diagnosed with anxiety post-TBI despite
concerns about cognitive and motor side effects and addictive properties.”

The study authors say that certain characteristics might explain

differences in treatment patterns between the two groups. Participants
with anxiety disorders after TBI were more likely to be older and female,
while those with PTSD after TBI were more likely to be younger and male.
Those with PTSD post-TBI were also more likely to have a substance use
disorder. “Thus, emerging from these data are questions about how
certain characteristics relate to diagnosis and subsequent treatment
decisions,” Marks and her colleagues write. “This question is prompted by
the observation that receipt of medication differs by diagnosis, despite the
significant overlap in indications.”

A limitation of the study was that the researchers did not exclude enrollees
who had been diagnosed with an anxiety disorder or PTSD prior to TBI. It
is therefore not possible to draw conclusions specific to new-onset anxiety
and PTSD.

“In all research based on administrative claims data, there are limitations
related to documentation of diagnoses, as well as whether or not the
medications were taken as prescribed,” Marks said. “Future studies
should examine treatment patterns based on race, gender, and age.”

“Results from our study raised the importance of access to mental health
care and evidence-based treatments for anxiety and PTSD post-TBI,” she
added. “Improving treatment can start by training our healthcare providers
in trauma-informed care, which can help providers recognize and initiate
conversations about mental health. Second, we should seek to build
stronger referral networks between medical locations treating TBI patients
and mental health practitioners.”

The study, “Treatment Patterns of Anxiety and Posttraumatic Stress

Disorder Following Traumatic Brain Injury”, was authored by Madeline R.
Marks, Moira C. Dux, Vani Rao, and Jennifer S. Albrecht.

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