[Nosologic aspects of personality change due to head trauma]

Personality change due to head injury is one of the most prevalent neuropsychiatric posttraumatic disorders and causes significant impairment in familial, social or occupational functioning.

To study the prevalence and clinical characteristics of personality changes secondary to severe closed head injuries, according to DSM-IV criteria.

Fifty-five patients (aged 15-65 years) with severe head trauma were studied during the chronic stage (11-3 months) with the following instruments: the Revised Iowa Collateral Head Injury Interview for the assessment of posttraumatic frontal symptoms, the Standardized Polyvalent Psychiatric Interview of Lobo et al, assessment of premorbid personality and its exacerbation, and the Scale of Aggressiveness of Yudofsky.

Thirty-three patients (60% of the sample) fulfilled DSM-IV criteria for personality change due to head injury; two thirds of them were combined or mixed type, which consists in the association of two or more types specified in the DSM-IV. The most prevalent types were apathic, unstable, disinhibited, aggressive, which are related with lesions in prefrontal cortex. There were nine patients with 'unspecified' symptoms, such as 'inappropriate euphoria' and 'poor insight', and other symptoms related to executive dysfunction.

One third of cases of personality changes were related to premorbid features; this fact argues against the exclusion of the criterium 'excerbation of premorbid personality traits' in DSM-IV. Only one third of posttraumatic personality changes can be classified according to DSM-IV and ICD-10 criteria. The high prevalence of symptoms related to deficit in self-awareness and executive dysfunction suggest the need of further investigations about nosology in this field.