Personality changes and return to work after severe traumatic brain injury: a prospective study

Abstract

Objective: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. Methods: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. Results: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). Conclusions: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition.

Letter to the Editor: Stereotactic injection of nondiffusible dyes

“…Feletti and Longatti for bringing to our attention their work on the stereotactic injection of methylene blue for delineating the border of brain tumors prior to surgery. 3,4 Their work predates our paper and clearly represents the first stereotactic injection of dye in the brain for these purposes. As such, they should be credited for proof of concept.…”

“…8 Most likely, this intimate relationship between cognitive deficits and personality changes explains the latter as a highly independent factor that is associated with not returning to work in survivors of severe TBI. 4 Noninvasive cerebral stimulation is a promising intervention for the treatment of cognitive impairment after TBI. 1 According to Villamar et al, 9 the acute recovery of cerebral functions after brain injury includes the activation of cellular repairs, which occurs in the earlier weeks following injury, cellular plasticity, and anatomical plasticity, including the formation of new connections.…”

Androgens, Male Hypogonadism and Traumatic Brain Injury

“…The primary damage from TBI and its subsequent imbalance may activate both secondary injury and neuroprotective cascades, which can interact with a complex biochemical network, leading to neuronal and glial survival or death due to necrosis and apoptosis [55][56][57][58]. Oxidative stress has been implicated with the excitotoxic brain injury [59], including TBI [60][61][62], but the association between plasma markers of oxidative stress and the severity of TBI patients' prognoses remains controversial [63]. An excessive amount of reactive oxygen species (ROS) generated by several combined mechanisms, including neutrophils activation, endothelial cells, nerve and glial cells, iron ions (from hemoglobin degradation in the hemorrhagic areas), and brain reperfusion [55,56,58], has been implicated in brain lesions in TBI.…”

Cross-cultural adaptation of the SCATBI instrument for cognitive-linguistic abilities after traumatic brain injury

“…This rapid deformation of brain anatomy and physiology results in clinical neurological and neurobehavioral impairments ultimately affecting an individual's cognition, vegetative and emotional functions, as well as social behavior abilities 3,5,6,7,8 . The TBI may result in multiple cognitive deficits.…”

“…The TBI may result in multiple cognitive deficits. The most commonly found sequelae are deficits in attention and memory, difficulty in learning new information, resolving problems, planning; as well as disturbances associated with impulsivity, self-control 9,10 and personality changes 3,5,6 . Currently, a limited number of test batteries has been developed to assess the presence and severity of cognitive-communicative deficits associated with TBI.…”