Personality change disorder in children and adolescents following traumatic brain injury

Abstract

The occurrence of personality change due to traumatic brain injury (PC), and its clinical and neuroimaging correlates were investigated. Ninety-four children, ages 5 through 14 at the time of hospitalization following traumatic brain injury (TBI; severe TBI N = 37; mild–moderate TBI N = 57), were assessed. Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, family psychiatric history, severity of injury, and neuroimaging assessments were conducted. The Neuropsychiatric Rating Schedule (NPRS) was used to establish a diagnosis of PC. Approximately 40% of consecutively hospitalized severe TBI participants had ongoing persistent PC an average of 2 years postinjury. An additional approximately 20% had a history of a remitted and more transient PC. PC occurred in 5% of mild–moderate TBI but was always transient. Interrater reliability for the diagnosis of PC was good (Kappa = .70). In severe TBI participants, persistent PC was significantly associated with severity of injury, particularly impaired consciousness over 100 hr, adaptive and intellectual functioning decrements, and concurrent diagnosis of secondary attention deficit hyperactivity disorder, but was not significantly related to any psychosocial adversity variables. These findings suggest that PC is a frequent diagnosis following severe TBI in children and adolescents, but is much less common following mild–moderate TBI. (JINS, 2000, 6, 279–289.)

Psychiatric outcomes after pediatric sports-related concussion

“…Personality change accounts for a substantial proportion of NPDs detected in previous studies of psychiatric disorders after TBI. 22,28,29,36 Although emotional lability, irritability, and apathy were endorsed among patients in this study, personality change disorders were not captured and likely lowered the prevalence of NPDs observed in this study. Third, studies have demonstrated that family functioning, socioeconomic status, and preinjury adaptive and intellectual function may contribute to the development of NPDs after pediatric TBI.…”

“…32 Novel psychiatric disorders diagnosed among patients with TBI in these studies were heterogeneous and included depressive disorders, anxiety disorders such as generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and OCD, somatoform disorder, ADHD, and behavioral disorders such as oppositional-defiant disorder and conduct disorder. 4,[21][22][23][26][27][28]30,[34][35][36]49 Among the most common NPDs observed among prospective studies has been personality change resulting from a generalized medical condition, which has been diagnosed in up to 40% of pediatric patients after TBI but was not formally assessed in the present study. 22,36 Clinical variables associated with the development of NPDs after pediatric TBI include history of preinjury psychiatric disorder, family history of psychiatric illness, severity of injury, low socioeconomic status, and preinjury adaptive and intellectual functioning.…”

“…Previous studies have observed novel psychiatric disorders (NPDs) occurring in 10%-100% of children and adolescents with TBI of various severities, including personality changes, attention-deficit hyperactivity disorder (ADHD), behavioral disorders, depression, and anxiety disorders. 4,21,22,[26][27][28]30,31,[33][34][35][36]49 Children and adolescents with psychiatric disorders are at risk for additional long-term comorbidities such as impaired school performance, 9 social isolation, 48 family dysfunction, 55 substance abuse, 45 and suicidal behavior. 19 Successful management of isolated pediatric mood disorders requires a multidisciplinary approach that includes behavioral and pharmacological treatment options.…”

Inhibition of Myosin Light-Chain Kinase Attenuates Cerebral Edema after Traumatic Brain Injury in Postnatal Mice

“…EB extravasation was significantly increased in saline treatment (Fig. 2G) ) and began approaching baseline by day 7 (2487 -927 vs. 428 -299 mm 2 ), compared to ML-7-treated mice (Fig. 2H).…”

“…1 Children with TBI are known to suffer a variety of cognitive and behavioral issues, including a loss in developmental milestones and difficulty achieving new ones, change in personality, decline in adaptive functioning, problems in school, and decreased participation in social activities. 2,3 Injured children less than 8 years of age may be especially vulnerable to declines in intelligence and executive functioning, causing difficulty in achieving their full potential and resulting in loss of future revenues. [4][5][6] TBI is a complex injury that leads to a cascade of events that result in compromise of the cognitive and physical functioning of the body.…”