Axis I and II Psychiatric Disorders After Traumatic Brain Injury: A 30-Year Follow-Up Study
Koponen S, Taiminen T, Portin R, Himanen L. ;
Commented by , 20 Aug 2002
Aim of the study
This is a 30 (or more) year follow-up of patients who had suffered a traumatic brain injury between 1950 and 1971.The aim of the study was to determine the frequency and type of mental disorders that began after the injury.
Method
Sixty patients with a history of brain injury were assessed for DSM-IV axis I and II disorders. Axis I disorders were assessed with the SCAN (Schedules for Clinical Assessment in Neuropsychiatry, Version 2.1), and axis II disorders with the SCID-II-R (Structured Clinical Interview for DSM-III-R Personality Disorders).
Organic personality syndrome was assessed according to DSM-III-R criteria. Cognitive impairment was assessed using the MMSE (Mini-Mental State Examination) and the Mild Deterioration Battery.
Results
Of the 60 patients, 29 (48.3%) had an axis I disorder that began after traumatic brain injury. The most common novel disorders after traumatic brain injury were major depression (26.7%), alcohol abuse or dependence (11.7%), panic disorder (8.3%), specific phobia (8.3%), and psychotic disorders (6.7%).
Fourteen patients (23.3%) had at least one personality disorder. The most prevalent individual personality disorders were avoidant (15.0%), paranoid (8.3%), and schizoid (6.7%) personality disorders.
Nine patients (15.0%) had DSM-III-R organic personality syndrome. Eight patients (13.8%) had very severe cognitive impairment according to the Mild Deterioration Battery.
Discussion
The rates of both lifetime and current major depression, panic disorder, and psychotic disorder found in patients after traumatic brain injury were significantly higher than the prevalences in the ECA survey.
The prevalences of personality disorder were significantly higher than those found in recent population studies. As such, the findings suggest that traumatic brain injury may cause psychiatric disorders or vulnerability to psychiatric disorders.
The strengths of the study include the assessment of both axis I and II psychiatric disorders with structured instruments and evaluation of cognitive functioning by a neuropsychological test battery.
The study has many limitations (e.g. retrospective follow-up, small numbers), which are discussed in detail by the authors. It is however the longest follow-up investigation ever reported on Axis I and Axis II disorders having occurred after traumatic brain injury.
The main finding of the study concerns the fact that traumatic brain injury is frequently followed by psychiatric disorders and that those disorders have a tendency to be long-lasting. The results of the study emphasize the importance of psychiatric follow-up of patients after traumatic brain injury.