Psychiatric aspects of traumatic brain injury

Traumatic brain injury (TBI) is defined as brain damage secondary to an externally inflicted trauma. It is an ongoing pandemic with an annual incidence of 2 million cases per year in the US.(28) Of these, approximately 500,000 require hospitalization and 80,000 suffer from chronic disability of some kind.(28) TBI is the leading cause of death and disability in people younger than 45 years of age, with an overall mortality rate of 25 deaths per 100,000. The age of peak incidence of head injury is 15 to 24 years, with males being injured two to three times more frequently than females.(56,99) Tables 1(80) and 2(55, 59) illustrate the causes and classification of head injury Advances in acute trauma care have improved survival significantly. This has led to a substantial increase in morbidity in patients who [GRAPHIC] survive TBI with psychiatric sequelae being central to their morbidity. Although physical disabilities typically stabilize with time, mood, cognitive, and behavior changes become the more disabling long-term impairments because they frustrate the patient, overwhelm the caregiver, and challenge the physician. Despite the common occurrence of psychiatric disorders following TBI very little literature about their epidemiology, pathophysiology, and management is available. Almost no randomized controlled studies about treatments for these psychiatric sequelae are available. This article reviews the common psychiatric conditions associated with TBI, highlighting two features: (1) the link between psychiatry and TBI and (2) the existing gaps in the literature regarding these disorders. We begin with a discussion of the pathophysiology and recovery from TBI. This is followed by classification of the psychiatric disorders associated with TBI and approaches to the evaluation and diagnosis of post-TBI patients. We conclude with a discussion of the clinical features and treatment of the psychiatric disorders.