Psychiatric aspects of traumatic brain injury

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EPIDEMIOLOGY

Traumatic brain injury (TBI) is defined as brain damage secondary to an externally inflicted trauma. It is an ongoing pandemic with an annual incidence of 2 million cases per year in the US.28 Of these, approximately 500,000 require hospitalization and 80,000 suffer from chronic disability of some kind.28 TBI is the leading cause of death and disability in people younger than 45 years of age, with an overall mortality rate of 25 deaths per 100,000. The age of peak incidence of head injury is 15

PATHOPHYSIOLOGY AND RECOVERY FROM TRAUMATIC BRAIN INJURY

This section is divided into (1) pathophysiology of brain injury and (2) recovery from brain injury.

Classification

TBI is associated with several psychiatric disturbances that are not always easy to classify. It may be possible to group together certain signs and symptoms as specific syndromes, but others may occur in isolation. Disturbances, such as irritability, insomnia, or fatigue, may be secondary to a comorbid psychiatric disorder, such as major depression, or may be a direct consequence of brain injury. Literature review also reveals a lack of uniformity in classifying the psychiatric sequelae.

EVALUATION AND DIAGNOSIS OF PSYCHIATRIC DISORDERS ASSOCIATED WITH TRAUMATIC BRAIN INJURY

The psychiatric evaluation of an individual with brain injury should be comprehensive and includes:

  • 1.

    History

    • 1.1.

      Demographic information

    • 1.2.

      Family history of psychiatric illness

    • 1.3.

      Personal history

      • 1.3.1.

        Birth and development

      • 1.3.2.

        Childhood health and behavior history

      • 1.3.3.

        Education

      • 1.3.4.

        Pre- and postinjury employment

      • 1.3.5.

        Pre- and postinjury marital status

      • 1.3.6.

        Pre- and postinjury living situation

    • 1.4.

      Drug and alcohol history

    • 1.5.

      Pre and post injury legal history

    • 1.6.

      Medical history

    • 1.7.

      Current medications

    • 1.8.

      Past psychiatric history

      • 1.8.1.

        History of hospitalization

      • 1.8.2.

        History

CLINICAL FEATURES AND MANAGEMENT OF PSYCHIATRIC SEQUELAE AFTER TRAUMATIC BRAIN INJURY

This section provides an only overview of the psychiatric disturbances associated with TBI because it is beyond the scope of this article to discuss in detail all the different psychiatric sequelae. The reader is encouraged to read the textbook Neuropsychiatry of Traumatic Brain Injury, edited by Silver et al96 for more information. This section has been divided into two parts: (1) general guidelines on the management of psychiatric sequelae and (2) clinical features.

SUMMARY

TBI is a complex heterogenous disease that can produce a variety of psychiatric disturbances, ranging from subtle deficits in cognition, mood, and behavior to severe disturbances that cause impairment in social, occupational, and interpersonal functioning. With improvement and sophistication in acute trauma care, a number of individuals are able to survive the trauma but are left with several psychiatric sequelae. It is important for psychiatrists to be aware of this entity because an

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