Psychiatric disorders and traumatic brain injury

Figures & data

Table 1 Summary of findings for psychiatric disorders after TBI

Findings	References
Depression
Incidence 15.3%–33%	Kim et al 2007
Prevalence 18.5%–61%	Kim et al 2007
Abnormalities on CT	Levin et al 2005
Lower bilateral hippocampal volume	Jorge et al 2007
Volume reduction of the left prefrontal grey matter	Jorge et al 2004
Left dorsolateral frontal and left basal ganglia lesions	Fedoroff et al 1992
Normal dexamethasone suppression test	Saran et al 1985
Unemployment	Seel et al 2003; Dikmen et al 2004; Jorge et al 2004
Poorer social functioning	Fedoroff et al 1992; Gomez-Hernandez et al 1997
Dissatisfaction with work; lack of close personal relationships	Gomez-Hernandez et al 1997
Less education; preinjury alcohol-related problems	Dikmen et al 2004
Lower economic status; aggression; anxiety	Jorge et al 2004; Jorge et al 1993c
Mania
Incidence 9%	Jorge et al 1993b
Prevalence 4.2%	van Reekum et al 2000
Higher rates for men	van Reekum et al 1996
Lesions in the temporal basal poles	Jorge et al 1993b; Murai and Fujimoto 2003
Seizures; more irritable mood and less euphoria	Shukla et al 1987
Aggression	Shukla et al 1987; DelBello et al 1999
Family history of mood disorders	Robinson et al 1988
Obsessive-compulsive disorder
Prevalence 1.6%–15%	Hibbard et al 1998; Deb et al 1999
Oribitofrontal cortex, cingulate cortex and caudate nucleus damage	Berthier et al 2001; Bilgic et al 2004; Ogai et al 2005
Obsessive slowness; compulsive exercises practice; aggression	Berthier et al 2001
Posttraumatic stress disorder
Incidence 11.3%–24%	Bryant and Harvey 1998; Bombardier et al 1999
Prevalence 3%–27.1%	Bryant et al 2000; Glaesser et al 2004
Increase of S–100B in the acute phase of TBI	Sojka et al 2006
Impaired quality of life and social function; chronic pain	Bryant et al 1999
Posttraumatic amnesia as a protective factor	Sbordone and Liter 1995; Glaesser et al 2004; Gil et al 2005
Lack of insight as a protective factor	Willians et al 2002
Depression; anxiety	Bombardier et al 1999; Bryant et al 1999; Glaesser et al 2004
Psychosis
Incidence 0.1%–9.8%	David and Prince 2007
Prevalence 0.7%	van Reekum et al 2000
Higher rates for men; previous TBI or neurological diseases	Fujii and Ahmed 2001
Most cases within 1 year after TBI; EEG abnormalities; seizures	Fujii and Ahmed 2002a
Damage in frontal and temporal lobes	Achte 1969; Sachdev et al 2001; Fujii and Ahmed 2002a
Predominance of positive symptoms	Sachdev et al 2001
Global cognitive impairment	Fujii and Ahmed 2004
Alcohol-related disorders
Prevalence before TBI 34.9%–51%	Kreutzer et al 1996b; Jorge et al 2005
Higher rates for men	Horner et al 2005; Jorge et al 2005
Generalized brain atrophy	Wild et al 2004
Changes in event-related potential testing	Baguley et al 1997
Prefrontal cortex volume reduction; relapse in patients with focal lesions	Jorge et al 2005
Less education; poorer vocational and social functioning	Jorge et al 2005
Return to the previous pattern of use after some months of abstinence	Kreutzer et al 1996b; Ponsford et al 2007
Depression	Walker et al 2003; Jorge et al 2005
Suicide	Mainio et al 2007
Personality changes
Apathy
Prevalence 34.5% after severe TBI	Pelegrín-Valero et al 2001
Younger age; more severe TBI	Kant et al 1998
Subcortical damage	Anderson et al 1999
Affective lability
Prevalence 5%–32.7%	Zeilig et al 1996; Pelegrín-Valero et al 2001
Frontal lobe damage; aggression; anxiety	Robinson et al 1993
Aggression
Prevalence 16.4%–33.7%	Pelegrín-Valero et al 2001; Tateno et al 2003
Frontal lobe damage	Grafman et al 1996; Tateno et al 2003
Depression	Tateno et al 2003; Baguley et al 2006
Poor preinjury social functioning; substance abuse	Tateno et al 2003

Table 2 Current state of knowledge on psychiatric disorders after TBI

Diagnosis

The current evidences do not allow the characterization of operational diagnostic criteria able to clearly define if a psychiatric disorder is caused by TBI.

The DSM-IV-TR recommendations, however, seem to be useful.

The lack of diagnostic criteria is marked on personality changes due TBI.

Epidemiology and associated factors

Incidence and prevalence rates were quite variable among studies.

Most studies used very heterogeneous samples.

Studies frequently have been limited by small samples, selection bias and loss to follow-up.

No studies had blind outcome assessment.

Except for PTSD, the role of TBI severity is poorly understood.

External validity of data is particularly limited on mild TBI.

Depression is the main psychiatric disorder after TBI.

Psychosocial factors seem to be relevant on depression after TBI.

Pathophysiology

Pathophysiological mechanisms of psychiatric disorders after TBI are largely unknown.

The psychiatric disorders after TBI may reveal clues about the mechanisms of the primary psychiatric disorders.

With regard to localization of brain damage, psychiatric disorders after TBI seem to have similarities compared to psychiatric disorders after other types of brain damage.

The frontal lobe may have an important role in the mechanism of the symptoms.

Neuroimaging findings are limited; no studies have approached functional methods.

Treatment

Most data derives from case reports and series.

Pharmacotherapy is still similar to the primary psychiatric disorders’ one; special care may be needed with regard to side effects and drug interactions.

KimELauterbachECReeveANeuropsychiatric complications of traumatic brain injury: a critical review of the literature (a report by the ANPA Committee on Research)J Neuropsychiatry Clin Neurosci2007191062717431056

 PubMed Web of Science ®Google Scholar

LevinHSMcCauleySRJosicCPPredicting depression following mild traumatic brain injuryArch Gen Psychiatry200562523815867105

 PubMed Web of Science ®Google Scholar

JorgeREAcionLStarksteinSEHippocampal volume and mood disorders after traumatic brain injuryBiol Psychiatry200762332817123480

 PubMed Web of Science ®Google Scholar

JorgeRERobinsonRGMoserDMajor depression following traumatic brain injuryArch Gen Psychiatry200461425014706943

 PubMed Web of Science ®Google Scholar

FedoroffJPStarksteinSEForresterAWDepression in patients with acute traumatic brain injuryAm J Psychiatry1992149918231609872

 PubMed Web of Science ®Google Scholar

SaranASDepression after minor closed head injury: role of dexamethasone suppression test and antidepressantsJ Clin Psychiatry19854633584019422

 PubMed Web of Science ®Google Scholar

SeelRTKreutzerJSRosenthalMDepression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigationArch Phys Med Rehabil2003841778412601647

 PubMed Web of Science ®Google Scholar

DikmenSSBombardierCHMachamerJENatural history of depression in traumatic brain injuryArch Phys Med Rehabil20048514576415375816

 PubMed Web of Science ®Google Scholar

Gomez-HernandezRMaxJEKosierTSocial impairment and depression after traumatic brain injuryArch Phys Med Rehabil199778132169421985

 PubMed Web of Science ®Google Scholar

JorgeRERobinsonRGStarksteinSEDepression and anxiety following traumatic brain injuryJ Neuropsychiatry Clin Neurosci1993c5369748286933

 PubMed Web of Science ®Google Scholar

JorgeRERobinsonRGStarksteinSESecondary mania following traumatic brain injuryAm J Psychiatry1993b150916218494069

 PubMed Web of Science ®Google Scholar

Van ReekumRCohenTWongJCan traumatic brain injury cause psychiatric disorders?J Neuropsychiatry Clin Neurosci2000123162710956565

 PubMed Web of Science ®Google Scholar

Van ReekumRBolagoIFinlaysonMAPsychiatric disorders after traumatic brain injuryBrain Inj199610319278735663

 PubMed Web of Science ®Google Scholar

MuraiTFujimotoSRapid cycling bipolar disorder after left temporal polar damageBrain Inj200317355812637187

 PubMed Web of Science ®Google Scholar

ShuklaSCookBLMukherjeeSMania following head traumaAm J Psychiatry19871449363799847

 PubMed Web of Science ®Google Scholar

DelBelloMPSoutulloCAZimmermanMETraumatic brain injury in individuals convicted of sexual offenses with and without bipolar disorderPsychiatry Res199989281610708275

 PubMed Web of Science ®Google Scholar

HibbardMRUysalSKeplerKAxis I psychopathology in individuals with traumatic brain injuryJ Head Trauma Rehabil19981324399651237

 PubMed Web of Science ®Google Scholar

DebSLyonsIKoutzoukisCRate of psychiatric illness 1 year after traumatic brain injuryAm J Psychiatry1999156374810080551

 PubMed Web of Science ®Google Scholar

BerthierMLKulisevskyJJGironellAObsessive-compulsive disorder and traumatic brain injury: behavioral, cognitive, and neuroimaging findingsNeuropsychiatry Neuropsychol Behav Neurol200114233111234906

 PubMedGoogle Scholar

BilgicBBaral-KulaksizogluIHanagasiHObsessive-compulsive disorder secondary to bilateral frontal damage due to a closed head injuryCogn Behav Neurol2004171182015453521

 PubMedGoogle Scholar

OgaiMIyoMMoriNA right orbitofrontal region and OCD symptoms: a case reportActa Psychiatr Scand200511174615636597

 PubMed Web of Science ®Google Scholar

BryantRAHarveyAGRelationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injuryAm J Psychiatry199815562599585713

 PubMed Web of Science ®Google Scholar

BryantRAMarosszekyJECrooksJPosttraumatic stress disorder after severe traumatic brain injuryAm J Psychiatry20001576293110739426

 PubMed Web of Science ®Google Scholar

GlaesserJNeunerFLütgehetmannRPosttraumatic Stress Disorder in patients with traumatic brain injuryBMC Psychiatry20044515113439

 PubMed Web of Science ®Google Scholar

SojkaPStalnackeBMBjörnstigUOne-year follow-up of patients with mild traumatic brain injury: occurrence of post-traumatic stress-related symptoms at follow-up and serum levels of cortisol, S-100B and neuron-specific enolase in acute phaseBrain Inj2006206132016754286

 PubMed Web of Science ®Google Scholar

BryantRAMarosszekyJECrooksJInteraction of posttraumatic stress disorder and chronic pain following traumatic brain injuryJ Head Trauma Rehabil1999145889410671704

 PubMed Web of Science ®Google Scholar

SbordoneRJLiterJCMild traumatic brain injury does not produce post-traumatic stress disorderBrain Inj19959405127640686

 PubMed Web of Science ®Google Scholar

GilSCaspiYBen-AriIDoes memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective studyAm J Psychiatry2005162963915863799

 PubMed Web of Science ®Google Scholar

WilliamsWHEvansJJNeedhamPNeurological, cognitive and attributional predictors of posttraumatic stress symptoms after traumatic brain injuryJ Trauma Stress20021539740012392227

 PubMed Web of Science ®Google Scholar

FujiiDEAhmedIRisk factors in psychosis secondary to traumatic brain injuryJ Neuropsychiatry Clin Neurosci20011361911207331

 PubMed Web of Science ®Google Scholar

FujiiDAhmedICharacteristics of psychotic disorder due to traumatic brain injury: an analysis of case studies in the literatureJ Neuropsychiatry Clin Neurosci2002a141304011983787

 PubMed Web of Science ®Google Scholar

AchteKAHillbomEAalbergVPsychoses following war brain injuriesActa Psychiatr Scand1969451185345563

 PubMed Web of Science ®Google Scholar

SachdevPSmithJSCathcartSSchizophrenia-like psychosis following traumatic brain injury: a chart-based descriptive and case-control studyPsychol Med200131231911232911

 PubMed Web of Science ®Google Scholar

FujiiDAhmedIHishinumaEA neuropsychological comparison of psychotic disorder following traumatic brain injury, traumatic brain injury without psychotic disorder, and schizophreniaJ Neuropsychiatry Clin Neurosci2004163061415377737

 PubMed Web of Science ®Google Scholar

KreutzerJSWitolADMarwitzJHAlcohol and drug use among young persons with traumatic brain injuryJ Learn Disabi1996b2964351

 PubMed Web of Science ®Google Scholar

JorgeREStarksteinSEArndtSAlcohol misuse and mood disorders following traumatic brain injuryArch Gen Psychiatry200562742915997015

 PubMed Web of Science ®Google Scholar

HornerMDFergusonPLSelassieAWPatterns of alcohol use 1 year after traumatic brain injury: a population-based, epidemiological studyJ Int Neuropsychol Soc2005113223015892908

 PubMed Web of Science ®Google Scholar

WildeEABiglerEDGandhiPVAlcohol abuse and traumatic brain injury: quantitative magnetic resonance imaging and neuropsychological outcomeJ Neurotrauma2004211374715000755

 PubMed Web of Science ®Google Scholar

BaguleyIJFelminghamKLLahzSAlcohol abuse and traumatic brain injury: effect on event-related potentialsArch Phys Med Rehabil1997781248539365356

 PubMed Web of Science ®Google Scholar

PonsfordJWhelan-GoodinsonRBahar-FuchsAAlcohol and drug use following traumatic brain injury: a prospective studyBrain Inj20072113–1413859218066940

 PubMed Web of Science ®Google Scholar

WalkerRHillerMStatonMHead injury among drug abusers: an indicator of co-occurring problemsJ Psychoactive Drugs2003353435314621132

 PubMed Web of Science ®Google Scholar

MainioAKyllonenTViiloKTraumatic brain injury, psychiatry disorders and suicide: A population-based study of suicide victims during the years 1988-2004 in Northern FinlandBrain Inj200721851517676442

 PubMed Web of Science ®Google Scholar

Pelegrín-ValeroCAGómez-HernándezRMuñoz-CéspedesJMNosologic aspects of personality change due to head traumaRev Neurol200132681711391499

 PubMed Web of Science ®Google Scholar

KantRDuffyJDPivovarnikAPrevalence of apathy following head injuryBrain Inj19981287929483342

 PubMed Web of Science ®Google Scholar

AndersonSWBecharaADamasioHImpairment of social and moral behavior related to early damage in human prefrontal cortexNat Neurosci199921032710526345

 PubMed Web of Science ®Google Scholar

ZeiligGDrubachDAKatz-ZeiligMPathological laughter and crying in patients with closed traumatic brain injuryBrain Inj19961059178836516

 PubMed Web of Science ®Google Scholar

RobinsonRGParikhRMLipseyJRPathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment studyAm J Psychiatry1993150286938422080

 PubMed Web of Science ®Google Scholar

TatenoAJorgeRERobinsonRGClinical correlates of aggressive behavior after traumatic brain injuryJ Neuropsychiatry Clin Neurosci2003151556012724455

 PubMed Web of Science ®Google Scholar

GrafmanJSchwabKWardenDFrontal lobe injuries, violence, and aggression: a report of the Vietnam Head Injury StudyNeurology199646123188628458

 PubMed Web of Science ®Google Scholar

BaguleyIJCooperJFelminghamKAggressive behavior following traumatic brain injury: how common is common?J Head Trauma Rehabil200621455616456391

 PubMed Web of Science ®Google Scholar