Psychiatric Illness After Traumatic Brain Injury

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Psychiatric Illness After Traumatic Brain Injury

• By Ri ???

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Introduction

• TBI impairs capacity to work and social
  activities.
• Neurobehavioral consequences had been well
  studied .
• Psychiatric syndrome rarely studied.

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TBI

• Working definition of TBI
• Period of loss consciousness, or
• Radiological evidence of brain assault, or
• Glasgow Coma Scale lt15

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General approach

• Use purpose-designed questionnaire
• Include basic data, initial GCS, psychiatric
  history/family history.
• Interview patient family members in acute stage
  lt3month and 1 year after TBI.

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Method

• Psychiatric screening
• General Health Questionnaire
• Psychosis Screening Questionnaire
• When screening (),
• Clinical Assessment in Neuropsychiatry
• Standard computer program (CATEGO)

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Result

• Disability by GOS
• 6.7 severe, 25.5 moderate, 58.3 non.
• 9.5 dead or vegetative state
• By General Health Questionnaire
• 62 patients positive in screening by
• 30 patients (18.3) ICD-10 psychiatric diagnosis
  by neuropsychiatry interview.
• Am J Psychiatry 1999 156374-378

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Result

• Classification of psychotic problem
• Depressive episode, 21 patients (12.8 95
  CI8.319.1)
• Panic disorder, 11 patients (6.7 95
  CI3.612.0)
• Nightmare, 7 patients (4.2 95 CI1.98.9).

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Results

• 3 patient GAD 2 patient OCD
• 1 phobic disorder, 1 schizophrenia.
• 4 patient post traumatic disorder.
• All these patients had memory of the incident
  involving the head injury.
• Only 10 of the 30 patients had a single
  psychiatric diagnosis.

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Results
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Discussion

• the first report
• higher rate of ICD-10 psychiatric diagnosis in
  TBI patient.
• higher depressive episode and panic disorder
  among TBI patients.

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Compared studies

• 42.42 of 66 head-injured patients suffered from
  major depression.
• 17 (25.75) in the acute stage,
• 11 (16.66) at 12-month follow-up.
• J Affect Disord 1993 27233243
• Anxiety symptoms 2428 TBI patients.
  Am J Psychiatry 1995, Brain Injury
  1996

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Compared studies

• Young group
• internalized symptoms withdrawal and closure,
• Older group
• hyperactivity and aggressiveness
• Brain Injury. 17(10)835-46, 2003 Oct
• Major depression 15.3 (N26) after TBI,
• Showed evidence of poorer outcome.
• Psychosomatics. 44(1)31-7, 2003 Jan-Feb

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Discussion

• Psychiatric history most important predictive
  factor.
• Multiple factors involved
• premorbid factors social class education
• head-injury-related factors low GCS
• outcome-related factors disability ()

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Conclusion

• Psychiatric disorder is significantly more in TBI
  patient.
• Multiple factors involves in the rate of
  psychiatric disorder in TBI patients.