TBI and Psychiatric Disorders
Clearly, a TBI (traumatic brain injury) can be a life-changing experience. Dr. Sam Goldstein reminds us that TBI often affect an individual’s overall mental health. Not only do structural changes in the brain affect personality, mood, etc, but so too does the task of coping with such a life-changing injury.
“The nature and incidence of psychiatric and emotional problems in adults suffering Traumatic Brain Injury was recently illuminated in a study reporting a thirty year follow-up of brain injured individuals. As has been reported in short term studies of emotional dysfunction following Traumatic Brain Injury, this study demonstrates that a significant number of individuals struggle long term with psychiatric disorders following Traumatic Brain Injury. Forty-eight percent of these individuals experienced an Axis I disorder that began after the Traumatic Brain Injury. Sixty-two percent had an Axis I disorder anytime during their lives. The most common disorders after Traumatic Brain Injury were major depression (27%), alcohol abuse or dependence (12%), panic disorder (8%), specific phobia (8%) and psychosis (7%). Fourteen subjects or 23% had at least one personality disorder. The most prevalent individual personality disorders were avoidant (15%), paranoid (8%), and schizoid (7%). Interested readers are referred directly to the article by Koponen and colleagues (American Journal of Psychiatry, August 2002, Volume 159, pages 1315-1321).
It is reasonable to conclude that Traumatic Brain Injury causes decades-lasting vulnerability to psychiatric illness in many individuals. In these individuals, appropriate care and treatment of emotional and behavioral problems may well speak to the difference between poor or adverse outcome. Clearly, additional research is needed to determine to what extent these adverse outcomes can be mitigated by early identification and appropriate diagnosis as well as psychosocial and medical intervention on a long-term, supportive basis. Further studies are also needed specifically of individuals with mild Traumatic Brain Injury. In clinical settings, it often appears that the long term adverse emotional and psychiatric problems these individuals experience may also be related to difficulty with chronic pain and stress.
These data highlight the importance of emotional, behavioral and psychiatric assessment as part of a comprehensive neuropsychological battery. It is my experience that for many individuals recovering from Traumatic Brain Injury, long-term prognosis and functioning is often better predicted by emotional regulation and psychiatric stability than eventual level of cognitive and neuropsychological function.”
This advice from Dr. Goldstein once again illustrates the far-reaching implications of a TBI. Treaters must target neuropsycholigical rehabilitation and functioning, but at the same time remain aware of other psychological impairments caused either physically by the actual injury or acquired during the recovery aftermath.
