The Challenges of Psychiatric Treatment for Cerebral Palsy

Every day, Dr. Daniel Linhares is exploring a new frontier in cerebral palsy psychiatric research. He is one of the only psychiatrists in the U.S. who specializes in treating patients with CP but has little literature to draw from when prescribing medication or making treatment recommendations. So he went ahead and researched it himself.

Dr. Linhares’ Journey to Caring for CP Patients

When he was a psychiatry resident, he found himself drawn to psychosomatic medicine, a subspecialty that treats patients with medical and psychiatric conditions. During his fellowship, he met with patients who had CP and found that many of them were fairly well-adjusted socially. He was impressed with their strength but knew there was something else going on beneath the surface.

“Resilience is sometimes mistaken for immunity,” said Dr. Linhares. “You look so resilient that no one is paying attention to the psychiatric part. I’ve come across more than a few patients that, when you actually dig into their history, you identify the significant depression that has been going on for a while.”

The State of Psychiatric Treatment for CP Patients

Treating CP patients with mental illness is particularly difficult. Depending on variables such as age or other medical disabilities or conditions, certain common psychiatric medications could have a negative effect on patients’ health. For example, SSRI medications are usually prescribed to treat depression but, if someone has a particular type of CP, there may be a higher chance of experiencing harmful side effects.

“In order to appropriate make a decision between psychotherapy and/or medication for treatment of depression, we need to know the safety and efficacy of these medications for our patients with CP,” said Dr. Linhares. “That’s why we need more research into the safety and side effects of these medications so that we can really assess the risk/benefits.”

What makes it even more challenging is that some doctors do not recognize other medical conditions that may be the underlying issue, which could exacerbate these ailments.

“If they’re not used to treating patients with cerebral palsy, they are more likely to say, ‘well, this is just the cerebral palsy,’” said Dr. Linhares. “They are not going to look further.”

EACD Research

Besides these complications, there is practically no literature on psychiatric treatments for CP patients. At a national psychiatric conference in the U.S., Dr. Linhares had two of the only poster presentations about treating CP patients. When he joined the Weinberg Family Cerebral Palsy Center, he made it a point to fill this research gap – starting with reviewing ten years of patient charts.

“Whatever is reported out there is probably less than what actually happened because this would require that the patient told the provider that they had depression or anxiety,” said Dr. Linhares.

After reviewing the charts, Dr. Linhares and his team compiled a list of common mental health diagnoses and prescriptions among CP patients. He took these findings to present at the European Academy of Childhood Disability (EACD) conference in Amsterdam. The symposium “Mental Health and Well-Being of Patients with Cerebral Palsy and Their Families” was co-presented by colleagues from the Weinberg CP Center, including Dr. David Roye, Tracy Pickar, and Hiroko Matsumoto. Dr. Linhares focused on psychiatric comorbidities, evaluation, and treatment.

Taking Care of Guardians

Although his primary focus is on patients with medical comorbidities, another aspect of Dr. Linhares’ research that was presented at the symposium is examining the care of parents and guardians of patients with CP. Many younger and older parents and guardians whose lives revolve around providing care can, eventually, become overwhelmed. If they don’t seek help, it could develop into major depression and, ultimately, impair their ability to care for their dependents.

“With guardians, we see a concern of who will be taking care of my child once I’m not here or if I am not available,” said Dr. Linhares. “You have to share the responsibility with others because, if you take ownership of the entire guardianship responsibility, the chances of burnout are much higher.”

He hopes that these caregivers can learn to take care of themselves and acknowledge their stress before these problems arise.

“When someone is seeking help, it’s usually because they are ready,” said Dr. Linhares. “When it’s such a severe form of depression, you can’t deny it anymore. If you don’t take care of yourself, you won’t be able to care for anyone else.”

Future Research Goals

Starting this semester, Dr. Linhares and his team are diving deeper into their original study, tracking the most commonly prescribed anti-psychotic and anti-depressant medications and any side effects among patients. This research includes looking into any comorbidity that may be present, such as cervical spinal stenosis or gastro-intestinal illnesses. While he is working on this research, he wants CP patients to advocate for their mental health and be vocal about their state of mind with their medical providers.

“It only takes 30-seconds to bring it up and, even if it seems like a small problem, when you dig deep, it could become something much bigger,” said Dr. Linhares. “All medical providers know one or two psychiatrists or mental health providers who can refer you to but, if you let the whole face-to-face interaction be about the medical condition, it’s only going to be about the medical condition.”