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Psychiatry & Psychology--General/Physiological or psychological?

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My husband suffered a brain injury at age 14 ( he is now 31) that required brain surgery and some skull reconstruction. He was involved in an accident that crushed in the right frontal part of his skull and caused a blood clot and brain swelling. He was comatose for several weeks but drs said he made a full recovery, except that he may have some issue with short term memory, which he does. It was recommended that he have an mri yearly, but he has failed to do so. He is also overweight (350 lbs) at 6'3" and has very high blood pressure. We have 2 children and both work full time jobs as well, so stress is abundant at times.
I have known him since he was 14, and i have noticed that from time to time he has somewhat manic mood swings, including agitation, inability to focus or concentrate, and irritability. Until about 2 years ago, he only had these episodes every 6 months or so, and it only lasted a few hours. He would be moody but more like someone simply aggravated with a bad day. Usually i could talk to him a little and he would snap out of it. These "swings" have continued to worsen in both frequency and severity as he now becomes unreasonable, defensive, cranky, and extremely selfish every couple of weeks and it lasts for days. He shows no signs of violence towards himself or others, but it is certainly taking a toll on our relationship as well as his relationships with the children. Its like he flips a switch and doesn't care about anyone but himself suddenly. A day or 2 later he is back to his normal, caring, thoughtful self. During these episodes he seems to have at least a few common symptoms of adhd, bi polar, depression, anxiety, ptsd and others. Im unsure where to start to seek help for him. Could his bp being high cause this ( he is on lisinopril/ hctz, but only takes it sporadically)? The brain trauma? Or is it purely psychological? I am aware that you cannot determine the specific cause, i just dont know whether, in a professionals opinion, i need to start with a different family doctor (we see an fnp) , or a mental health professional? Are any of his physical issues capable of causing his symptoms? Or would it be more likely that the psychological problem is causing the physical concerns? I know emotional stress causes high bp, but his seems to be inherited and im unsure whether this being mostly uncontrolled can cause the emotional problems (like low blood sugar, maybe?). Any advice or opinions you can offer will be greatly appreciated, and again, im aware you cant diagnose, i am simply hoping for a direction to start looking in. Thank you for your time!

Answer
hi, nikki, thanks for your question.

You asked "The brain trauma? Or is it purely psychological?"
---- there is no way to tell, of course. It could be caused by either, both, or neither. An injury to the right frontal lobe could cause a number of personality changes, including emotional dysregulation, impulse control, difficulty with changes in the environment, difficulty stopping, etc.

" i need to start with a different family doctor (we see an fnp) , or a mental health professional?"
--- in order to rule in or rule out brain problems, you have to see brain doctors - either a neurologist. Just remember that not every "problem" is something you need to be concerned about or have treatment for. We all have strengths and weaknesses - the questions you should ask include - how does this compare to the average person, and how does this affect his daily life?

Also know that you can't fix every problem, and you should not try to fix everything. Pick you battles. An ounce of prevention is worth a pound of cure. There are a number of types of techniques that you can choose from - meds, counseling, behavior modification, cognitive therapy, environmental changes, etc.

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Psychiatry & Psychology--General

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Bruce Borkosky, Psy.D.

Expertise

any related to psychology, especially related to forensic psychology

Experience

15 years as a licensed psychologist, 15 years in private practice. My practice began primarily doing individual and group psychotherapy, is now devoted to assessments, but I occasionally do take on clients in therapy.

Organizations
American Psychological Association

Education/Credentials
B.A. psychology, B.A., music, Ohio Wesleyan U., 1978 MCS, computer science, University of Dayton, 1984 MA, psychology, Miami Inst. of Psychology, 1991 Psy.D., psychology, Miami Inst. of Psychology, 1993 post doctoral training in Neuropsychology, Fielding Institute, 1995-1997

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