Psychiatric aspects of traumatic brain injury
Section snippets
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
- 1.3.1.
- 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
- 1.8.1.
- 1.1.
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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Multipotential and systemic effects of traumatic brain injury
2021, Journal of NeuroimmunologyTraumatic brain injury and the misuse of alcohol, opioids, and cannabis
2021, International Review of NeurobiologyCitation Excerpt :Primary injury is produced immediately by the traumatic external force and can be focal or diffuse. Focal injury may involve cortical or subcortical contusions, fractures, hemorrhages, and hematomas, while diffuse injury most frequently involves diffuse axonal injury (DAI; Rao & Lyketsos, 2002). DAI is produced because of acceleration–deceleration forces and angular movements of the head that lead to shearing and eventual tearing of axonal fibers (Gennarelli & Graham, 1998).
Hippocampal cognitive impairment in juvenile rats after repeated mild traumatic brain injury
2020, Behavioural Brain ResearchCitation Excerpt :Together, these assessments of learning and memory suggest that r-mTBI impairs hippocampal-dependent learning and memory Interestingly, although personality changes such as an increase in risk-taking behavior [62–65] and anxiety [52,66–69] have been reported following mTBI, we did not observe this in our animals. In the clinical population, personality changes such as risk-taking behaviours following mTBI have been reported [62–65] and anxiety has been shown to develop in 10–70% of mTBI patients [52,66–69].
Post-injury administration of a combination of memantine and 17β-estradiol is protective in a rat model of traumatic brain injury
2017, Neurochemistry InternationalNeurocognitive and Psychiatric Issues Post Cardiac Surgery
2017, Heart Lung and CirculationImproving Traumatic Brain Injury Outcomes: The Development of an Evaluation and Referral Tool at Groote Schuur Hospital
2017, World NeurosurgeryCitation Excerpt :This observation has influenced the design of the GSH TBI-E in that the questionnaire now enables psychological/psychiatric presentations to be better identified, whereas the algorithm helps guide the clinician to refer patients who present with cognitive and psychological/psychiatric impairments to neuropsychological services first, wherever possible. It is vital to assess TBI severity given its correlation with morbidity and mortality and with high rates of cognitive and psychological/psychiatric problems.21,22 This notion was supported in this study, where the participants with severe TBI indicated higher rates of cognitive difficulties (94%) and psychological/psychiatric problems (97%) compared with participants with mild to moderate injuries—45% and 54%, respectively.