Abstract: Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients’ care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this fi eld is discussed.
Keywords: psychiatric disorders, traumatic brain injury, neuropsychiatry, diagnostic, epide-miology, pathophysiology.
Introduction
One of the fi rst detailed reports of psychiatric symptoms following traumatic brain injury (TBI) was the famous case of Phineas Gage, a construction worker who, in 1848, survived an accident in which an iron bar went through his skull, seriously damaging the frontal lobe. His doctor, John Harlow, described his personality changes: from being a responsible and socially well-adapted man, Gage became negligent, irreverent and profane, unable to take responsibility (Damásio et al 1994). The systematized study of the topic was only established at the beginning of the 20th century by Adolf Meyer. He published comprehensive case reports about patients who presented behavior disturbances after head injuries and proposed a set of disorders called “traumatic insanities”, which included consciousness alterations, psychosis, and neurological symptoms (Neylan 2000). Since then, many efforts have been done to improve knowledge in this area, but it still constitutes a fertile fi eld for research, with many gaps to be fi lled. In spite of considerable amount of papers in the literature, their levels of scientifi c evidence are frequently low. The importance of the theme is justifi ed due to the high incidence of TBI and to the personal suffering and social cost in consequence of this pathology.
The present review encloses data on epidemiology, diagnosis, associated factors and treatment of psychiatric disorders after TBI. Delirium, amnesic disorder, dementia, and postconcussional syndrome are not included here. Although they are described in the psychiatric diagnostic manuals, these conditions are more strongly associated to a general medical approach, which diverges from the proposed aim of this review.