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Neuropsychiatric Aspects of Traumatic Brain Injury.

Arciniegas1, Topkoff, Silver

  • 1Departments of Psychiatry and Neurology, University of Colorado Health Sciences Center, Campus Box C268-68, 4200 East 9th Avenue, Denver, CO 80262, USA. david.arciniegas@uchcs.edu

Current Treatment Options in Neurology
|November 30, 2000
PubMed
Summary

Traumatic brain injury (TBI) can cause neuropsychiatric issues. Effective management requires thorough assessment, psychotherapy, support groups, and cautious medication use, prioritizing patient history and symptom reassessment.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Rehabilitation Medicine

Background:

  • Traumatic brain injury (TBI) frequently leads to diverse neuropsychiatric problems, including cognitive impairment, mood disturbances, and behavioral changes.
  • Management guidelines for these post-TBI symptoms are scarce, despite their common occurrence.
  • Many symptoms are direct consequences of brain injury, not necessarily comorbid psychiatric disorders.

Purpose of the Study:

  • To recommend a structured approach for evaluating and treating neuropsychiatric problems following TBI.
  • To emphasize the importance of comprehensive patient assessment in guiding treatment decisions.
  • To provide guidance on psychotherapeutic and psychopharmacological interventions.

Main Methods:

  • Comprehensive patient assessment including developmental, psychiatric, and medication history.

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  • Detailed mental status and neurological examinations.
  • Quantification of neuropsychiatric symptoms using standardized inventories (e.g., Neurobehavioral Rating Scale, Neuropsychiatric Inventory).

    • Main Results:

    • Symptoms must be evaluated within the context of premorbid history and current treatments.
    • Psychotherapy and TBI support groups are crucial components of management.
    • Cautious medication dosing (low and slow), continuous reassessment, and avoidance of certain drug classes (sedative, antidopaminergic, anticholinergic, benzodiazepines) are recommended.

    Conclusions:

    • A systematic evaluation is essential before initiating any treatment for post-TBI neuropsychiatric symptoms.
    • Treatment should be individualized, integrating psychotherapy, support, and carefully managed pharmacotherapy.
    • Augmentation strategies with low-dose agents may be necessary when monotherapy is insufficient or not tolerated.