Multispecialty Collaboration in Mild Traumatic Brain Injury (mTBI): The Critical Role of Psychiatrists in Diagnosis, QEEG, and Neurofeedback (NFB)

Lauro Amezcua-Patino, MD, FAPA.
4 min readDec 22, 2024

by Lauro Amezcua-Patino, MD, FAPA (Medical Director, Neuron-Connect)

by Lauro Amezcua-Patino, MD, FAPA (Medical Director, Neuron-Connect)

Mild Traumatic Brain Injury (mTBI), commonly referred to as a concussion, is a multifaceted condition with diverse cognitive, emotional, and behavioral consequences. While neurologists address structural and vascular changes, psychiatrists bring unique expertise in diagnosing and treating the neuropsychiatric sequelae of mTBI, often incorporating advanced tools like Quantitative EEG (QEEG) and Neurofeedback (NFB) to enhance patient outcomes. For medical providers and attorneys, understanding the psychiatrist’s role in mTBI care — including their expertise in QEEG and NFB — is vital for clinical and legal advocacy.

The Role of Psychiatrists in mTBI Diagnosis and Management

Psychiatrists are uniquely positioned to address the neuropsychiatric symptoms of mTBI, which often extend beyond the scope of standard neurological evaluations. Their expertise spans:

1. Diagnosing Neuropsychiatric Sequelae:

• Identifying mood, behavioral, and cognitive impairments caused by subtle disruptions in brain function, even in the absence of gross structural damage.

2. Utilizing Advanced Diagnostics:

• Employing QEEG to assess functional brain changes and guide individualized treatment.

3. Innovative Interventions:

• Implementing Neurofeedback (NFB) to promote neuroplasticity and optimize recovery in patients with persistent symptoms.

Advanced Psychiatric Tools: QEEG and NFB

Quantitative EEG (QEEG)

QEEG is a sophisticated diagnostic tool that measures and maps brainwave activity to detect abnormalities in neural function:

How It Works:

• QEEG analyzes electrical activity in the brain, identifying deviations from normative patterns that may not be visible on traditional MRI or CT scans.

• In mTBI, QEEG often reveals dysregulated activity in regions associated with attention, memory, and mood regulation, such as the frontal and temporal lobes.

Applications in mTBI:

Cognitive Dysfunction: Identifying areas of hypo- or hyperactivity linked to cognitive deficits, such as impaired attention or memory.

Emotional Symptoms: Mapping abnormalities in regions associated with mood regulation, such as the prefrontal cortex or limbic system.

Integration with Treatment:

• QEEG data can guide targeted interventions, including psychopharmacology, cognitive therapy, or NFB.

Neurofeedback (NFB)

NFB is a non-invasive therapy that uses real-time feedback to train patients to regulate their brainwave activity:

How It Works:

• Patients engage in exercises where they receive visual or auditory feedback about their brainwave patterns.

• Over time, this feedback enables patients to achieve healthier neural activity patterns, enhancing self-regulation.

Applications in mTBI:

Cognitive Rehabilitation: Improving attention, working memory, and processing speed by training specific brain regions to normalize activity.

Mood Regulation: Reducing symptoms of anxiety, irritability, and emotional dysregulation by targeting dysfunctional neural circuits.

Clinical Evidence:

• Studies have shown that NFB can significantly improve cognitive and emotional outcomes in patients with persistent mTBI symptoms.

Collaborative Roles in mTBI Management

1. Neurologists:

Focus: Diagnosing and managing structural and vascular complications, such as hemorrhage or ischemia.

Tools: Imaging studies like MRI, CT, and DTI.

2. Psychiatrists:

Focus: Addressing neuropsychiatric symptoms, including mood disorders, cognitive deficits, and behavioral changes.

Tools:

• Comprehensive neuropsychiatric evaluations.

• Advanced diagnostics, including MRI, CT, and DTI, QEEG, to detect functional brain changes.

• Interventions like NFB, psychotherapy, and pharmacotherapy.

3. Neuropsychologists:

Focus: Conducting detailed cognitive assessments and rehabilitation.

Tools: Formal testing and cognitive-behavioral interventions.

4. Rehabilitation Specialists:

Focus: Physical and occupational therapy to address motor and functional impairments.

Tools: Adaptive strategies and exercises.

Case Study: Integrating QEEG and NFB in Psychiatric Care

Patient: A 28-year-old athlete suffers a concussion during a soccer game. After two months, they report:

• Persistent headaches and fatigue (neurological symptoms).

• Difficulty concentrating and irritability (neuropsychiatric symptoms).

• Emotional outbursts and insomnia (behavioral symptoms).

Neurologist’s Role:

• Orders imaging to rule out structural damage, which comes back normal.

• Diagnoses post-concussion syndrome and prescribes medication for headaches.

Psychiatrist’s Role:

1. Evaluation:

• Identifies cognitive impairments and emotional dysregulation through a detailed neuropsychiatric assessment.

• Administers QEEG, revealing dysregulated activity in the frontal cortex (associated with attention and emotion) and temporal lobes (linked to memory and mood).

2. Treatment:

• Implements NFB sessions targeting these regions, training the patient to normalize brainwave patterns.

• Prescribes an SSRI for mood stabilization and insomnia.

• Collaborates with a neuropsychologist for cognitive rehabilitation exercises.

Outcome:

• Over three months, the patient demonstrates improved attention, emotional stability, and sleep patterns, enabling a gradual return to sports and daily activities.

Legal Implications: The Psychiatrist’s Role in mTBI Cases

For attorneys, psychiatric expertise in mTBI, including the use of QEEG and NFB, can be pivotal in:

Disability Claims:

Psychiatrists provide evidence of functional impairments that impact work capacity and quality of life.

Personal Injury Litigation:

QEEG data offers objective evidence of brain dysfunction, supporting claims of injury even when traditional imaging is inconclusive.

Competency Evaluations:

Psychiatrists assess how mTBI affects decision-making, emotional control, and cognitive functioning in legal contexts.

Conclusion: Psychiatrists as Leaders in Comprehensive mTBI Care

Psychiatrists bring a unique and indispensable perspective to the diagnosis and management of mTBI. Their expertise in neuropsychiatric evaluations, combined with advanced tools like QEEG and NFB, enables them to address the often subtle but life-altering impacts of mTBI. By collaborating with neurologists, neuropsychologists, and rehabilitation specialists, psychiatrists ensure a holistic approach that enhances patient recovery and supports legal advocacy.

As mTBI research advances, psychiatrists remain at the forefront, integrating innovative diagnostics and therapies to bridge the gap between brain and behavior, ultimately improving outcomes for patients navigating the challenges of mTBI.

by Lauro Amezcua-Patino, MD, FAPA (Medical Director, Neuron-Connect)

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Lauro Amezcua-Patino, MD, FAPA.
Lauro Amezcua-Patino, MD, FAPA.

Written by Lauro Amezcua-Patino, MD, FAPA.

Dr. Lauro Amezcua-Patiño: Bilingual psychiatrist, podcaster, clinical leader, educator, and researcher. Expert in forensic medicine and mental health issues.

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