Understanding the neuropsychiatric consequences associated with significant traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) can give rise to a variety of neuropsychiatric syndromes. The objective of this review is to describe the neurobiological mechanisms that have been proposed to underlie many of these post-TBI syndromes, explore the utility of various investigative modalities and review the mechanisms of treatment available for them.
METHODS: Six authors reviewed PubMed and Ovid literature that addressed TBI in the context of the neuropsychiatric sequelae, evaluation and management.
RESULTS: Depressed mood, anxiety, impulsive/aggressive behaviour, impaired memory and sleep disturbances are among the most prevalent sequelae of severe TBI. Delirium, while less common, can also result from TBI, predisposing individuals to other psychiatric conditions, while psychosis, usually presenting with atypical features, is relatively rare. The evaluation of the brain following TBI has often relied on traditional structural imaging which, according to recent studies, is less sensitive than chemical and functional neuroimaging. A variety of pharmacologic and non-pharmacologic treatments have been investigated with varying degrees of success in managing the spectrum of post-TBI psychiatric illnesses.
CONCLUSIONS: Neuropsychiatric sequelae are common following TBI. Several of these syndromes are amenable to treatment. Further investigations are required, however, to better understand the mechanistic aetiology of these conditions and the effectiveness of various therapeutic modalities.