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Neuropsychiatric Problems After Traumatic Brain Injury: Unraveling the Silent Epidemic

Received December 4, 2007; revised April 1, 2008; accepted April 2, 2008. From The Johns Hopkins School of Medicine, Division of Geriatric Psychiatry and Neuropsychiatry, Dept. of Psychiatry and Behavioral Sciences; Alexian Brothers Behavioral Health/Alexian Brothers Neurosciences Institute; and the Depts. of Psychiatry and Behavioral Sciences, Rehabilitation Medicine, and Epidemiology, The University of Washington. Send correspondence and reprint requests to Jesse R. Fann, M.D., M.P.H., Dept. of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195. e-mail: fann{at}u.washington.edu
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Traumatic brain injury (TBI) is a significant public health concern. According to the Centers for Disease Control and Prevention, about 1.4 million people in the United States sustain a TBI annually. OBJECTIVE: This review places particular emphasis on the current knowledge of effective treatment of TBI symptoms, and proposes directions for future research. RESULTS: Neuropsychiatric problems are more prevalent and longer-lasting in TBI patients than in the general population. About 40% of TBI victims suffer from two or more psychiatric disorders, and a similar percentage experience at least one unmet need for cognitive, emotional, or job assistance 1 year after injury. The entire spectrum of TBI severity, from mild to severe, is associated with an increase in psychiatric conditions. CONCLUSION: Despite the high incidence of severe consequences of TBI, there are scarce empirical data to guide psychiatric treatment. Some approaches that have been helpful include cognitive and behavioral therapy and pharmacologic treatment. The authors list specific research recommendations that could further identify useful therapeutic interventions.

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