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Anxiety and Stress Disorders

Speech Problems Caused by Stress or A TBI

06/25/2007

Question:

I’m an RN and was working in a long term care facility; the floor I was working on was a rehap skilled floor. The floor really is like a med-surge unit, many patients would be a week post-op. All w/medication management, several w/wound care, many w/IV therapy. The difference with this place compared to the hospital, even though the acuity level was the same, a hospital nurse would have max 6 patients/nurse. This place one nurse cared for 25-40 patients. I found so many things wrong with the place I turned them in to the state board. Wound care not being done, but being signed off, Medication orders not being followed which could have resulted in a client’s death. (I give this as an idea of the stress I was under at the time) A week prior to my calling the State board I started having constant headaches, and then I started having miner speech problems. I got to the point I had trouble with concentration, I realized I would look at my watch and then at the MAR but couldn’t connect the time and couldn’t make the correct judgment for giving medications at the right time. I was asked to give a voluntary resignation notice 4 days after the state started investigating from the phone call I had made to them. When the DNS asked me to write the note, she had to tell me word for word how to right this note. I had lost the ability to even structure a simple sentence. 2 hours later I was visiting a friend, she made me call a psychiatrist I have been seeing for a history of PTSD and Depression. I was having extreme problems with speech. He sent me to the ER for an eval. They did labs and a CT-scan. Labs came out normal, the CT-scan only showed a frontal lobe damage from 34 years ago when I was in a MVA. The next day I saw both my psychiatrist and my PCP. My PCP said I sounded like someone learning a new language; he set me up with an MRI for the following day. I saw a neurologist the next week, she could find nothing wrong and said she just thought it was a conversion disorder. It took me over a month to start to speak and write correctly. Even now it doesn’t take to much stress and I slip back. The higher the level of stress the more my writing and speech skills are effected.

(More history) At age 12, I was in a MVA. I was riding a horse and there was a head on collision with a truck. My horse’s head went through the windshield killing an 8 year old boy in the truck. I flew over the truck hit the tail gait causing compound fractures in both femurs. I then landed on the pavement behind the truck head first. I was in a Coma for 3 days.

My sister said she noticed I was having speech problems for the last few years, I didn’t notice this until the incident with my previous job. All through this I have had no feelings of depression, it is almost like whatever happened to my brain during this time short circuited and burned out the depression aspect, Although it is usually SAD and the weather has been very good.

Here is my question. Is the problem with my speech, writing and decreased concentration skills related to the increase in stress or can a TBI of 34 years ago still have increasing effects on a person? IF so what do I have to look forward to? Thank You for your time....

Answer:

It sounds like you have some excellent health care professionals caring for you -- a primary care provider, a psychiatrist, a neurologist.  With such a specific question as you are asking, I really am unable to add anything to what your physicians have already told you.  Anxiety related disorders can certainly cause the symptoms you are describing, however, only the physicians examining and caring for you can determine the specific cause of your problem.  I encourage you to ask them your question.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati