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Semin Neurol 2015; 35(01): 064-082
DOI: 10.1055/s-0035-1544241
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neuropsychiatric Disturbances Associated with Traumatic Brain Injury: A Practical Approach to Evaluation and Management

Vani Rao
1   Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Vassilis Koliatsos
1   Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
2   Departments of Pathology and Neurology, Division of Neuropathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Faizi Ahmed
1   Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Constantine Lyketsos
1   Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Kathleen Kortte
3   Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
25 February 2015 (online)

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Abstract

Traumatic brain injury (TBI) causes a wide variety of neuropsychiatric disturbances associated with great functional impairments and low quality of life. These disturbances include disorders of mood, behavior, and cognition, and changes in personality. The diagnosis of specific neuropsychiatric disturbances can be difficult because there is significant symptom overlap. Systematic clinical evaluations are necessary to make the diagnosis and formulate a treatment plan that often requires a multipronged approach. Management of TBI-associated neuropsychiatric disorders should always include nonpharmacological interventions, including education, family involvement, supportive and behavioral psychotherapies, and cognitive rehabilitation. Pharmacological treatments include antidepressants, anticonvulsants, antipsychotics, dopaminergic agents, and cholinesterase inhibitors. However, evidence-based treatments are extremely limited, and management relies on clinical empiricism and resemblance of TBI neuropsychiatric symptom profiles with those of idiopathic psychiatric disorders. Although the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed including prospective, longitudinal studies to explore biomarkers that will assist with management and prognosis as well as randomized-controlled studies to validate pharmacological and nonpharmacological treatments. The current review summarizes the available literature in support of a structured, systematic evaluation approach and treatment options as well as recommendations for further research directions.

Keywords

traumatic brain injury - neuropsychiatry - postconcussion - depression - posttraumatic stress disorder - chronic traumatic encephalopathy - anxiety - mood - mania - behavior - psychosis - apathy - sleep
 

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