Psychiatric disturbances after traumatic brain injury: Neurobehavioral and personality changes

Abstract

Traumatic brain injuries (TBI) are frequently accompanied by psychiatric disturbances, which can include striking to relatively minor alterations in personality, behavior, and emotional regulation. The persistence of these neurobehavioral syndromes often leads to deleterious effects on recovery and rehabilitation outcomes. A recent surge of studies has emerged in the past several years to quantify the extent of psychiatric disorders in TBI and to describe differential clinical presentations. Various pre- and post-injury factors also have been hypothesized to contribute to the development and maintenance of psychiatric symptoms in survivors of brain injuries. The identification of high-risk individuals with distinct neuropathophysiological and psychosocial features permits the development of multidisciplinary and tailored approaches to the assessment, prevention, and management of the negative effects of personality and behavioral changes in TBI. This article summarizes the most recent research in these areas and highlights the gaps that need to be filled in subsequent future.

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

“…While mTBI has been shown to have unique effects on health and functioning [20][21][22][23], we focus on the overlap of mTBI with PTSD and depression because these most commonly present together, and cognitive complaints are important overlapping features of all three conditions [11][12][13][14][15][16]. We hypothesize that self-reported cognitive symptoms that adversely affect daily functioning at the level of moderate to very severe are more strongly associated with individual mental health disorders and with mental health disorders in conjunction with mTBI than with mTBI alone.…”

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…Combined with impaired judgment, poor insight, self-awareness and self-monitoring (Flashman & McAllister, 2002;Hart, Seignourel, & Sherer, 2009), increased impulsivity, and memory and social skills deficits, it is not surprising that TBI patients may have psychosocial and interpersonal problems and poorly integrate into their communities and families without a comprehensive program of rehabilitation. Pre-morbid emotional and personality characteristics may become exaggerated or muted, while in others there may be a dramatic change in personality (Prigatano, 1992;Warriner & Velikonja, 2006). Paranoia and schizophrenia-like symptoms may appear after moderate and severe TBI and characterized by negative symptoms such as, heightened suspiciousness and social withdrawal, rather than delusions and hallucinations (Guerreiro, Navarro, Silva, Carvalho, & Gois, 2009;Zhang & Sachdev, 2003).…”

Health Care Costs Associated with Traumatic Brain Injury and Psychiatric Illness in Adults

“…The estimated average lifetime cost of a severely injured TBI patient is between $600,000 and $1.875 million (Centers for Disease Control and Prevention, 2010). In addition, long-term neuropsychiatric sequelae of TBI, such as cognitive dysfunction, depression, and anxiety, are common among both civilians and veterans, and may require psychiatric treatment (Warriner and Velikonja, 2006). Even mild TBI can be associated with significant and long-lasting neuropsychological impairment, but there is a clear association between severity of TBI and neuropsychological cost (Hessen et al, 2007;Massagli et al, 2004).…”