Clinical Characteristics of the Casualties Referred from the Court for Mental Disability Evaluation after Traffic Accident / 신경정신의학

ABSTRACT

In an attempt to obtain the basic data for mental disability evaluation in psychiatric casualties by traffic accidents, 88 cases referred fiom the court for the purpose of mental disability evaluation for 3 years from 1994 to 1996 were surveyed. The results are summarized as follows: 1) Among the 88 cases, 58 cases(65.9%) were male and 30(34.1%) were female. Cases with low educational and socioeconomic levels outnumbered those with high educational and socioeconomic levels. More than half of the cases were in socially active group with ages of 21 to 50 years. 2) At the time of accidents, 71.6% of the whole cases were diagnosed as cerebral contusion, which was the most common diagnosis. The next common diagnoses were skull fracture(36.4%), brain hemorrhage(33.0%), brain hematoma(26.1%), cerebral concussion(12.6%), and axonal injury(10.2%) in order of frequency. In 9.1% of the cases there was no definite evidence of head injury was found. 3) During the period of mental disability evaluation, the most common symptom was cognitive symptom(85.2%), and the next common symptoms were somatic(83.0%), behavioral(69.3%), and affective(58.0%) ones in order of frequency. On the other side, the most common psychopathology recognized by the psychiatrists was affective symptom, which was present in 80.9% of the cases manifested during the period of evaluation, and the next common psychopathologies were behavioral(77.3%), cognitive(63.6%), and somatic(40.9%) symptoms in order of frequency. 4) Nearly half(48.8%) of the whole patients manifested psychiatric symptoms such as cognitive, affective, behavioral, and somatic symptoms between the first and sixth months after traffic accidents. Only 9.1% of the cases developed psychiatric symptoms after six months of traffic accidents. Meanwhile, 61.4% of the cases were never given psychiatric treatments despite the presence of psychiatric symptoms, and 23.5% of the cases given psychiatric treatments visited psychiatrists after six months of symptom development. 5) All of the cases took neuroimaging studies such as brain CT or MRI and EEG during the feriod of mental disability evaluation. In 47.7% of the cases there were abnormal findings in neuroimaging studies among which encephalomalacia was the most frequent. The next abnormal findings were brain atrophy, axonal injury, cyst, and so on in order of frequency. On the other hand, in 86.4% of the cases EEG findings were within normal limit. 6) In 95.5% of the cases, mental disorders were confirmed, among which personality change due to head trauma was the most common, and the next common mental disorders were dementia due to head trauma, adjustment disorder, depressive disorder due to head trauma, postconcussional disorder, posttraumatic stress disorder, and so on in order of frequency. More than one third of the cases(38.1%) given psychiatric diagnoses were considered to need continuous psychiatric treatments at the time of mental disability evaluation. 7) Posttraumatic decline in intelligence tended to be affected by loss of consciousness and delirium, but not by skull fracture and brain surgery. In brain imaging and EEG studies performed during the period of mental disability evaluation, posttraumatic decrease in intelligence tended to be influenced by abnormal findings on brain imaging, but not EEG findings.