Axis I and II psychiatric disorders in patients with traumatic brain injury: a 12-month follow-up study.

OBJECTIVE: To evaluate the occurrence of axis I and II psychiatric disorders among patients with traumatic brain injury (TBI). DESIGN: Prospective observational study. Forty-five adult patients, who had attended an emergency unit because of TBI, were recruited. At 12 months, 38 patients were interviewed. MEASURES: Psychiatric disorders were evaluated using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). RESULTS: Before TBI, the 12-month rate of axis I psychiatric disorders was relatively high (39.5%) and the rate of alcohol dependence was especially elevated (18.4%). During the 12 months after TBI, axis I disorders were found in 47.4% of subjects. Six patients (15.8%) were found to have a disorder with an onset after TBI. Of these, five patients had depressive disorders (13.2%). Almost one third of the subjects (29.0%) had personality disorders. Antisocial and obsessive-compulsive personality disorders were the most frequent (10.5%). CONCLUSIONS: Both axis I and II psychiatric disorders are common among patients with TBI. Alcohol dependence and personality disorders are prevalent in individuals prone to TBI, whereas depressive disorders typically develop after injury. Psychiatric disorders should be addressed in rehabilitation, as otherwise they will hinder the recovery after TBI.

Risk factors for reduced survival after traumatic brain injury: a 30-year follow-up study.

PRIMARY OBJECTIVE: To evaluate risk factors for reduced survival in subjects with traumatic brain injury (TBI). PARTICIPANTS AND METHODS: A retrospective follow-up of three decades included 192 subjects with TBI. Cognitive testing was carried out on average 2 years after the injury (at mean age of 39.0 years), during the years 1966-1972. Cox's regression and logistic regression analyses were used and the survival of the subjects was compared with the general population using the standardized mortality ratio (SMR). RESULTS: Reduced survival was significantly associated with age at injury (p < 0.001) and vocational outcome (p = 0.003). Vocational outcome in turn was associated with age (p = 0.010), TBI severity (p < 0.001), cognitive impairment (p = 0.010), later TBIs (p = 0.007) and alcohol abuse (p = 0.015). Mortality in the younger patient group (age at death <40 years) was higher than in the general population (SMR 4.50, 95% CI = 2.02-10.01). CONCLUSIONS: A reduced working ability, influenced by age-, injury- and lifestyle-related factors, is associated with long-term survival after TBI. The mortality among younger patients is high, a finding which should be considered when planning the care after TBI.

Association of injury severity, MRI-results and ApoE genotype with 1-year outcome in mainly mild TBI: a preliminary study.

PRIMARY OBJECTIVE: To study the ability of MRI findings, apolipoprotein E (ApoE) genotype, the Glasgow Coma Score (GCS) and duration of post-traumatic amnesia (PTA) to predict the 1-year outcome in traumatic brain injury (TBI). RESEARCH DESIGN: A prospective study in unselected emergency room patients with an acute TBI, followed for 1 year. METHODS AND PROCEDURES: Thirty-three consecutive patients were studied. The TBI severity was assessed with GCS and duration of PTA. Brain MRI scans were obtained within approximately 1 week post-injury. The ApoE genotypes were determined by standard methods. The outcome was evaluated with the Head Injury Symptom Checklist and the Glasgow Outcome Scale (extended) 1 year after the injury. The prognostic value of the explanatory variables was evaluated with multiple linear regression analysis. MAIN OUTCOMES AND RESULTS: The presence of traumatic axonal injury lesions or contusions in MRI and duration of PTA were independent predictors of poor outcome. The ApoE genotype and GCS were not associated with outcome. CONCLUSIONS: In multivariate models, the duration of PTA and acute MRI are the best predictors of 1-year outcome in TBI, whereas the prognostic values of GCS and ApoE are modest. The dominating role of GCS in assessing TBI severity should be questioned.

Attention and depressive symptoms in chronic phase after traumatic brain injury.

OBJECTIVE: To study whether attention deficits differ between TBI (traumatic brain injury) patients with and without depressive symptoms. METHOD: The study group (n = 61, mean age = 59 years) consisted of symptomatic TBI patients injured on average 30 years earlier. They were studied with a broad range of attention tasks including computerized methods. The patients were divided into those with depressive symptoms (n = 32) and those without (n = 29), according to the short form of the Beck depression scale with a cut-off score of 5. In addition, a diagnosis of major depression was applied according to the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (n = 6). The groups with depression or depressive symptoms were compared with the non-depressed TBI patients and with an age- and education-matched healthy control group (n = 31). RESULTS: Cognitive methods that require flexibility (Trail making B, Card sorting, Word fluency) and working memory (Subtraction test) were sensitive to discriminate TBI patients without depressive symptoms from the control subjects (p < 0.001). Only a few methods were able to discriminate the TBI patients with depressive symptoms from those without (p < 0.001 for Simple reaction time, p < 0.003 for Vigilance test). The depressed TBI patients (assessed by SCAN) did not differ from the non-depressed TBI patients in attention functions. CONCLUSIONS: The results suggest that problems in complex attention processing are more specific to TBI, while slowness in simple psychomotor speed and impaired sustained attention may be mostly related to depressive symptoms in patients with chronic TBI sequelae.

MRI changes and ApoE genotype, a prospective 1-year follow-up of traumatic brain injury: a pilot study.

PRIMARY OBJECTIVE: To examine the association between apolipoprotein E (ApoE) genotype and visibility of traumatic brain lesions during the first year after traumatic brain injury (TBI). RESEARCH DESIGN: A prospective 1-year follow-up study in unselected victims of TBI. METHODS: The number and extent of contusions, ventricular size index and semi-quantitative score of other traumatic intraparenchymal lesions were determined with MRI approximately 1 week and 1 year after TBI and the results were analysed in relation to the ApoE genotype in 33 patients after acute non-trivial TBI. RESULTS: The ApoE genotype was not associated with the visible changes occurring during this follow-up. CONCLUSIONS: The presence of ApoE4 was not associated with MRI changes during the first year after TBI. This suggests that if the ApoE4 is associated with an unfavourable outcome after TBI, the processes responsible for the repair of visible lesions are not dependent on ApoE genotype.