Psychiatric treatment outcome following traumatic brain injury

Abstract

The relationship between self-reported history of traumatic brain injury (TBI) and psychiatric treatment outcome was investigated. TBI was hypothesized to be frequent, associated with cognitive deficits on neuropsychological testing, and less amenable to standard psychiatric treatment. Subjects were 42 psychiatric patients with a self-reported history of TBI and 25 psychiatric patients with no TBI history. Subjects received approximately 2 weeks of inpatient psychiatric treatment. Subjects received neuropsychological testing and completed the Brief Symptom Inventory weekly. TBI was frequent (66% of subjects); multiple injuries were common. Neuropsychological performance was generally average in both groups with few group differences. Subjects, on average, reported significantly decreased psychiatric symptoms on discharge. However, the TBI group appeared to improve less than the control group; group status was a significant predictor of treatment outcome. Implications of results for assessment and treatment of psychiatric disorders in patients with a history of TBI are discussed.

Traumatic Brain Injury History Among Individuals Using Mental Health and Addictions Services: A Scoping Review

“…Gender was not clearly defined and was reported as man/woman or male/female, thus appearing to be conflated with biological sex. Among 5 studies finding a relationship between TBI history and sex/gender, male participants were consistently found to have a higher prevalence of TBI 29,30,34,49,53,56…”

“…Ten studies examined diagnostic categories in relation to TBI history 29–31,42,43,47,53–57. Diagnostic conceptualizations varied between studies (eg, using different editions of the Diagnostic and Statistical Manual of Mental Disorders ).…”

“…Seven studies assessed the severity of participants' mental health symptoms 29–31,35,37,39,49,53. Four studies used various structured scales for symptom assessment29,30,35,39,53 and 3 used unstructured methods 31,37,49. Five studies found that TBI status was associated with more severe mental health symptoms29,30,37,39,49,53 (such as increased psychological distress29,30 or depression scale scores39,53), while 2 found no relationship 31,35…”

“…This variable was assessed in different ways by 12 studies, including formal neuropsychological test batteries,29,30,39,46,51 clinically recorded indicators such as IQ or use of special education services,31,42,43 and self-reported difficulties with cognitive function or school/learning 36,37,46,53,55. Seven studies reported that TBI status was associated with challenges including recent difficulty with understanding, concentrating, and remembering,37,49 word-finding problems,36 academic challenges,46,53 or worse performance on one or more neuropsychological tests 29,30,39. Four studies found no relationship,31,43,51,55 and, notably, 1 reported no difference in cognition variables between participants with and without TBI history of any severity, but found that participants with mild TBI history only had slightly higher performance IQ than participants with no TBI 42…”

“…The search and screening results are presented in Figure 1. Twenty-seven journal articles and 2 dissertations were included in the review, describing 28 unique studies (1 study being reported by both a dissertation and journal article29,30). Included documents were published between 1990 and 2018, originating from the United States ( n = 23), Canada ( n = 2), the United Kingdom ( n = 2), New Zealand ( n = 1), and Norway ( n = 1).…”