Epidemiology and Natural History of Psychiatric Disorders After TBI

Abstract

This article outlines the epidemiology of psychiatric disorders in individuals with traumatic brain injury (TBI), with a focus on DSM axis I disorders diagnosed on the basis of structured clinical interview. The epidemiology of psychiatric disorders in the general population is described as a basis for understanding the disorders that occur before and after TBI. For each disorder category, including mood disorders, anxiety disorders, acute stress disorder, posttraumatic stress disorder (PTSD), substance use disorders, psychotic disorders, eating disorders, somatoform disorders, and adjustment disorders, the evidence from retrospective, cross-sectional and prospective studies is reviewed, showing the frequency, time course, and predictors of the disorders. Studies show elevated rates of depressive and anxiety disorders after TBI, most commonly major depressive disorder and PTSD, usually emerging in the first year postinjury but with delayed onset in severe injury cases. Although individuals with a preinjury history are more likely to develop these disorders, the nature of the disorders may change after injury, and novel psychiatric disorders are also common. Even though the frequency of anxiety disorders diminishes over the years postinjury, depressive disorders are more persistent during postinjury years. Substance use-while high before injury-declines after injury. The frequency of psychotic, eating, somatoform, and adjustment disorders do not exceed population rates.

Prophylaxis Pharmacotherapy to Prevent the Onset of Post-Traumatic Brain Injury Depression: A Systematic Review

“…Depression is one of the most common and disabling psychiatric complications that occurs following traumatic brain injury (TBI) 1,2 with studies reporting between 30% and 77% of individuals with TBI develop depression in the first twelve months post injury depending on the study design, irrespective of severity. [2][3][4] Rates of depression in persons with TBI are up to 7.9 times higher than rates reported in the general population. 5 Depressive symptoms may include; sadness, irritability; fatigue; sleep disturbances; detachment from social activities, difficulties with concentration and memory difficulties.…”

Using clinical quality databases to monitor the quality of fundamental care: Example with weight status after severe traumatic brain injury

“…This is supported by findings of increased appetite or eating disturbances in 27% of individuals with severe TBI undergoing neurorehabilitation (Ciurli, Formisano, Bivona, Cantagallo, & Angelelli, 2011). However, others argue that post‐TBI eating disorders present at rates comparable to those in the general population (Ponsford, Alway, & Gould, 2018), and therefore, overeating as explanation for weight gain is dubious.…”

De-Rationalising Delusions

“…Furthermore, cognitive impairment is neither necessary nor sufficient for the production of delusions as the vast majority of patients with even quite severe cognitive difficulties, for example after traumatic brain injury, do not develop delusions as a consequence, and indeed do not show rates that markedly differ from the general population (Ponsford, Alway, & Gould, 2018). Clearly, some delusions arise after brain injury, dementia, alterations to the nervous system and so on, but there are no reliable instances of cognitive impairment independent of aetiology that reliably raise the risk of developing delusions.…”