Pre-existing bipolar disorder followed by brain injury: A challenge to rehabilitation

The purpose of this study was to study the influence of preexisting bipolar disease in individuals with acquired brain injuries. 3 patients, ages 19, 26 and 56 years, presented to an outpatient clinic with recent onset of brain injuries, in addition to a previously diagnosed bipolar disease that was well controlled on lithium carbonate. The onset of brain injuries occurred 1, 2 and 8 years after the onset of bipolar disorder respectively. Loss of consciousness was noted for a few seconds in 1, and 4 days in each of the other 2. Two had college degrees, and 1 hand a high school diploma. All 3 had new onset of cognitive deficits post brain injury. Their neuropsychological evaluations revealed attention deficits in all 3, and all 3 also presented with a variety of other cognitive deficits, including mild memory deficits, visuospatial deficits, and decreased executive skills. 2 patients had an exacerbation of bipolar symptoms. All 3 had difficulty participating in rehabilitation and returning to school or employment, often due to denial of one or both conditions. Brain injuries alone with similar magnitude of neuropsychological deficits often result in better outcomes than in these 3 cases. Thus, bipolar disease, even though well controlled, may complicate the outcome of brain injury rehabilitation and requires careful physiatric and psychiatric management.