Chapter

Mood Instability

David L Brody

in Concussion Care Manual

Published on behalf of Oxford University Press

Published in print August 2014 | ISBN: 9780199383863
Published online March 2015 | e-ISBN: 9780190205270 | DOI: https://dx.doi.org/10.1093/med/9780199383863.003.0009
Mood Instability

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Often the complaint of mood instability comes from the collateral source. The first priority is to assess safety. Severe mood instability can lead to suicide. Next, determine whether the problem is actually mood instability, as opposed to sustained major anxiety, depression, or post-traumatic stress disorder. Nonpharmacological interventions are the most important, and include education, sleep management, prescription for cardiovascular exercise, pain control, cessation of alcohol and other disinhibiting substances such as levetiracetam (Keppra), and cognitive behavioral therapy. Preferred pharmacological options that do not substantially impair cognitive recovery include lamotrigine (Lamictal) and oxcarbazepine (Trileptal). Other options include carbamazepine (Tegretol) when cost is an issue, propranolol (Inderal) when violence is a concern, and low dose atypical antipsychotics.

Chapter.  1355 words.  Illustrated.

Subjects: Neurology

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