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Published on: October 12, 2014
Psychiatric disorders after traumatic intracranial hemorrhage: the HEAD Helsinki study
Janne Kinnunen1, Jukka Putaala2, Ivan Marinkovic2
1Department of Neurology, Meilahti Hospital, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland. janne.kinnunen@helsinki.fi.
Insights
Psychiatric disorders are common after traumatic intracranial hemorrhage (tICH), affecting one in six patients. Younger age increases risk, while prior medication and lower GCS scores predict treatment needs.
Area of Science:
- Neuroscience
- Psychiatry
- Public Health
Background:
- Psychiatric disorders following head injuries are often underestimated.
- This study investigates the prevalence and treatment of psychiatric disorders after traumatic intracranial hemorrhage (tICH).
Purpose of the Study:
- To assess the long-term prevalence and treatment patterns of psychiatric disorders in patients with tICH.
- To identify factors associated with the development of psychiatric disorders and subsequent treatment needs.
Main Methods:
- An observational, retrospective cohort study of tICH patients from the HEAD Helsinki study.
- Data collected from Helsinki University Hospital between 2010 and 2019, including psychiatric diagnoses and treatments.
- Logistic regression analysis used to determine associations between clinical characteristics and psychiatric outcomes.
Main Results:
- 17.1% of tICH patients developed psychiatric disorders during a 10-year follow-up.
- Over half of those diagnosed received secondary level psychiatric care, and 60.6% initiated new psychotropic medications.
- Younger age was linked to psychiatric disorder development, while prior psychiatric medication and lower GCS scores predicted treatment.
Conclusions:
- A significant proportion of patients treated for tICH develop psychiatric disorders requiring secondary care.
- Early identification and intervention for psychiatric conditions post-tICH are crucial.
- Younger patients and those with specific clinical indicators require closer psychiatric monitoring.
Background:
The extent of psychiatric disorders after head injury is not well recognized. We assessed the prevalence and treatment of psychiatric disorders after traumatic intracranial hemorrhage (tICH) in a 10-year follow-up.
Methods:
An observational, retrospective single-center cohort of tICH patients from HEAD Helsinki (Head trauma related health care Economics, Acute care and Development of long-term outcomes in Helsinki city region) study hospitalized at Helsinki University Hospital between 01 January and 31 December 2010. We reported primary outcomes as psychiatric disorders and their subsequent treatment on secondary level psychiatric care during the follow-up period between January 2010 and December 2019. Logistic regression analysis was performed to study associations between admission clinical characteristics and primary outcomes.
Results:
In our cohort of 385 patients (mean age 60.7 years, 66.5% male) with tICH, 66 (17.1%) had any psychiatric disorders during the follow-up period (median time 108 months, IQR 92 months), and 48 (72.1%) of them experienced new psychiatric disorders (median time to onset 29.5 months, IQR 64 months), of which 26 (54.2%) were without any psychiatric history prior to tICH. A total of 35 patients (53.0%) received secondary level psychiatric care, and 40 (60.6%) patients had initiated new psychotropics (median time to initiation 8 months, IQR 40 months). Compared to patients without psychiatric disorders, those with psychiatric disorders were younger (mean age 49.1 vs. 63.1 years, p < 0.001) and had less frequently larger (> 100 ml) intracranial hemorrhages (21.2 vs. 44.2%, p = 0.001). In multivariable analyses, younger age was independently associated with the development of any psychiatric disorders. Prior psychiatric medication and lower admission GCS score were associated with consequent psychiatric treatment.
Conclusions:
Every sixth patient treated in a tertiary level neurosurgical unit had psychiatric disorders diagnosed at secondary level care after tICH and over half of them received secondary level psychiatric care. Psychiatric disorders development was associated with younger age whereas prior psychiatric medication and lower admission GCS score indicated subsequent psychiatric treatment.
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