WRNMMC, Bethesda, Md.   –   Walter Reed National Military Medical Center (WRNMMC) has the Department of Defense’s only Neuropsychiatry/Traumatic Brain Injury (TBI) Unit. It serves as a referral program for Military Health System (MHS) beneficiaries throughout the defense department, as well as for congressional members needing care for the impacts of head injuries and other behavioral health challenges.

Military medicine has been at the forefront of advances in health care, many born out of the tragedy of war, including the ambulance emergency room system, anesthesia, prosthetics, and the now, the treatment of TBI. The Neuropsychiatry/TBI Unit is helping to lead that charge.

Dr. David A. Williamson, a neuropsychiatrist, is medical director of the Neuropsychiatry/TBI Unit at Walter Reed. He explains the unit treats patients who’ve experienced head injuries, cerebrovascular accidents, and illnesses that fall under neurological and mental challenges.

“I became interested in behavioral health because of a fascination with the human brain,” Williamson shares. “Perhaps the most advanced ability of the human brain is social cognition. Our brains mediate the expression and understanding of language, emotions and behaviors that lead us to affiliate, and through that develop complex social networks that become our families, communities and organizations. Unfortunately, many brain injury patients have profound impairments in their ability to communicate and maintain those relationships. Behavioral health providers are important in brain injury treatment because we understand communication, relationships, emotions, and behavior.”

Williamson calls the MHS innovative in its support of developing a neurobehavioral team embedded in a trauma hospital -- Walter Reed. He is one of a very small number of doctors in the country trained in brain injury medicine and neuropsychiatry, two separate pathways. He explains the unit at Walter Reed is set up primarily to treat brain injuries in service members, many who are Special Forces.

“The picture of head injuries has changed,” Williamson adds. “Instead of a large number of serious, penetrating head injuries with fragments and gunshot wounds to the head, we have many more people who have had repeat minor injuries, such as small blast exposures and impact injuries from jumping out of airplanes and other training accidents.”

He said these injuries, repeated over time, have caused degraded performance and function mentally. The degradation is often complicated by patients suffering from additional conditions that affect brain function, including sleep disorders, headaches, balance challenges, post-traumatic stress, and depression. All these conditions can affect memory, concentration, and overall cognitive performance.

The Neuropsychiatry/TBI Unit also evaluates and treats patients with other brain conditions. “We care for patients who have experienced brain injuries, strokes, seizures, encephalitis (brain inflammation), and infections,” Williamson adds. He explains many of these patients present with the types of symptoms that psychiatrists typically see, but their cause is not primarily psychiatric illnesses. “Another way to think of it is as medical psychiatry, or psychiatry with medical causes for the symptoms.”

“We best serve patients with an interdisciplinary treatment team,” Williamson says, explaining good health care is a collaborative process. He also describes his unit as a “one-stop-shop platform,” which evaluates beneficiaries for headaches, memory challenges, balance issues, post-traumatic stress, and sleep concerns, as well depression and other mental health presentations. “The important thing is that with the support of the specialty services available at Walter Reed, we do everything,” he adds.

He shares that treatment could include physical therapy, sleep therapy, and medication, and incorporate providers from orthopedics, neurosurgery, and other hospital services. He says patients are also encouraged to exercise and eat healthy. “We have a holistic approach to care.”

“Treatment depends on what we find during the workup, and it could be a package of things,” Williamson adds.

People who develop complex symptoms of conditions that are difficult to diagnose are referred to the unit for care, Williamson says. Those symptoms may include confusion, memory loss in young people for which there is no ready explanation, and other aspects of brain performance that may change for unexplained reasons.

“I believe that good health care is a collaborative process and that we best serve patients with an interdisciplinary treatment team,” Williamson continues. “I work closely with other providers around the country, and I will follow the patients after discharge from [our] program to ensure long-term treatment plans are implemented, and to offer support for future challenges. I keep in contact with families long after treatment at [WRNMMC]. I believe we can support them throughout the long journey of TBI treatment. I often bring patients back to re-evaluate medications, explore new medical findings, or provide respite for caregivers,” he adds.

“A win is a return to duty. That’s the goal,” Williamson says. “Many of our patients are highly motivated and want to return to duty.”

Williamson adds the patient’s family is also important to care. “To fully understand the challenges faced by brain injury patients, it is important to assess not just the patient, but also the people who form their support system and how those individuals and the patient interact. So, patient- and family-centered care is at the heart of brain injury treatment. Our patients’ families will be their long-term support, and we need to monitor the health and resilience of caregivers and patients,” he explains.

As DOD’s only neuropsychiatrist, Williamson is nationally renowned for his comprehensive and holistic approach to treating the long-term behavioral, relational, and emotional symptoms of patients who have suffered TBI and other challenges. He is also credited with remaining engaged with his patients after treatment, helping them achieve the highest level of independence and quality of life possible, which is measured by their ability to return to duty or home, rather than being placed in nursing homes or assisted living facilities, according to the National Council for Mental Wellbeing, comprised of more than 3,100 mental health and substance use treatment organizations. The council focuses on the care of adults and children facing mental health and addiction challenges. In 2016, it recognized Williamson as its doctor of the year.