Logo for the Journal of Rehab R and D

Volume 46 Number 6, 2009
   Pages 757 — 796

Abstract —  Neuropsychiatric diagnosis and management of chronic sequelae of war-related mild to moderate traumatic brain injury

Joshua D. Halbauer, MD;1-3 J. Wesson Ashford, MD, PhD;1-3* Jamie M. Zeitzer, PhD;1-3 Maheen M. Adamson, PhD;1-3 Henry L. Lew, MD, PhD;1,4 Jerome A. Yesavage, MD1-3

1Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA; 2VA, Sierra-Pacific Mental Illness Research, Education and Clinical Center and War-Related Illness and Injury Study Center, Palo Alto, CA; 3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, CA; 4Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA

Abstract — Soldiers with a traumatic brain injury (TBI) present with an array of neuropsychiatric symptoms that can be grouped into nosological clusters: (1) cognitive dysfunctions: difficulties in memory, attention, language, visuospatial cognition, sensory-motor integration, affect recognition, and/or executive function typically associated with neocortical damage; (2) neurobehavioral disorders: mood, affect, anxiety, posttraumatic stress, and psychosis, as well as agitation, sleep problems, and libido loss, that may have been caused by damage to the cortex, limbic system, and/or brain stem monoaminergic projection systems; (3) somatosensory disruptions: impaired smell, vision, hearing, equilibrium, taste, and somatosensory perception frequently caused by trauma to the sensory organs or their projections through the brain stem to central processing systems; (4) somatic symptoms: headache and chronic pain; and (5) substance dependence. TBI-related cognitive impairment is common in veterans who have served in recent conflicts in the Middle East and is often related to blasts from improvised explosive devices. Although neurobehavioral disorders such as depression and posttraumatic stress disorder commonly occur after combat, the presentation of such disorders in those with head injury may pass undetected with use of current diagnostic criteria and neuropsychological instruments. With a multidimensional approach (such as the biopsychosocial model) applied to each symptom cluster, psychological, occupational, and social dysfunction can be delineated and managed.

Key words: affective, aggression, agitation, attention, communication, executive function, language, memory, pain, PTSD, rehabilitation.

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