TY - JOUR
T1 - Neuropsychiatric disturbances associated with traumatic brain injury
T2 - A practical approach to evaluation and management
AU - Rao, Vani
AU - Koliatsos, Vassilis
AU - Ahmed, Faizi
AU - Lyketsos, Constantine
AU - Kortte, Kathleen
PY - 2015/2
Y1 - 2015/2
N2 - 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.
AB - 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.
KW - anxiety
KW - apathy
KW - behavior
KW - chronic traumatic encephalopathy
KW - depression
KW - mania
KW - mood
KW - neuropsychiatry
KW - postconcussion
KW - posttraumatic stress disorder
KW - psychosis
KW - sleep
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=84923668444&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84923668444&partnerID=8YFLogxK
U2 - 10.1055/s-0035-1544241
DO - 10.1055/s-0035-1544241
M3 - Article
C2 - 25714869
AN - SCOPUS:84923668444
SN - 0271-8235
VL - 35
SP - 64
EP - 82
JO - Seminars in Neurology
JF - Seminars in Neurology
IS - 1
ER -