Psychiatric Issues in Traumatic Brain Injury
Traumatic Brain Injury has significant and distinct psychiatric effects. The following is a brief discussion of what those effects can be:
- Loss of consciousness - Can be either brief or protracted. On recovery of consciousness, patients develop confusion, agitation, disorientation and delirium.
- Cognitive deficits - Impairement in efficiency and speed of information processing, attention and vigilance are seen in most cases.
- Memory - Newly acquired knowledge is forgotten.
- Perception - Visual dysfunction affects about 50% of TBI patients. Visuo-perceptual disturbances such as impaired figure-ground perception and constructional abilities may be present in severe TBI as part of a general cognitive decline.
- Language - Anomia and word finding difficulties are present after TBI.
- Intelligence - Both performance and verbal IQ are reduced in acute and chronic phases of severe TBI. Recovery of verbal IQ is faster. Performance IQ continued to be lower even after three years.
- Personality change - Personality change may result from neurochemical changes or from psychological reaction to TBI. Common changes include excessive tiredness, indifference, concentration and attention disorders, inflexibility, perseveration, inability to anticipate,
behavioural disinhibition, irritability, change in quality of relationship with shallowness and obsessive-compulsive symptoms. - Aggression - Physical/verbal aggression and impulsiveness are particularly difficult for family members to manage.
- Sexuality - Limbic structures particularly amygdala, septal nuclei and hypothalamus which form the neuroanatomic and physiologic substrate of human sexual behaviour may be damaged in TBI, resulting in impaired sexuality.
- Alcohol abuse - Many TBI patients are intoxicated at the time of injury. Presence of high alchohol levels in blood not only has a negative impact on length of unconsciousness and behavioural changes and neurocognitive changes but can also affect mortality. Alcohol abuse in the previously head injured can result in pathological intoxication.
- Post Concussional Syndrome (PCS) - PCS was the commonest neuropsychiatric sequelae after TBI.
- Mood disorders - Following TBI, depression is more common than mania. Depression occurs more frequently with lesions of frontal and temporal lobes and left anterior lesions.
- Psychoses - Paranoid psychoses can occur independently or as part of post-traumatic dementia.
Psychiatrists and specifically, neuropsychiatrists, rely on their medical training and use of the DSM-IV-TR to make specific diagnosis for patients who suffer from traumatic brain injury.
