Psych Vivas · Consultation-liaison psychiatry
TBI psychiatry — structured clinical viva
Fellowship viva on TBI psychiatry: burden and mild TBI, personality change, depression rates and sertraline, aggression drug evidence, mania and psychosis after TBI.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CL psychiatry registrar. Rehab medicine asks you to review a 38-year-old man 4 months after severe TBI (GCS nadir 7, prolonged PTA, right orbitofrontal contusion). Issues: major depression with suicidal ideation; intermittent aggression; family report of personality change; staff requesting regular risperidone. Discuss the burden of TBI, psychiatric sequelae, depression evidence, the aggression drug evidence, and psychosis after TBI.
Interpretation
Reveal interpretationShowHide
Personality change. Moderate and severe TBI can cause personality changes including impulsivity, severe irritability, affective instability and apathy.[6]
References8ShowHide
- [1]Maas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. The Lancet. Neurology, 2022.PMID 36183712
- [2]Bombardier CH, Fann JR, Temkin NR, et al. Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA, 2010.PMID 20483970
- [3]Fann JR, Bombardier CH, Temkin N, et al. Sertraline for Major Depression During the Year Following Traumatic Brain Injury: A Randomized Controlled Trial. The Journal of head trauma rehabilitation, 2017.PMID 28520672
- [4]Plantier D, Luauté J, SOFMER group Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice. Annals of physical and rehabilitation medicine, 2016.PMID 26797170
- [5]Fujii D, Ahmed I Characteristics of psychotic disorder due to traumatic brain injury: an analysis of case studies in the literature. The Journal of neuropsychiatry and clinical neurosciences, 2002.PMID 11983787
- [6]Howlett JR, Nelson LD, Stein MB Mental Health Consequences of Traumatic Brain Injury. Biological psychiatry, 2022.PMID 34893317
- [7]Jorge RE, Robinson RG, Starkstein SE, et al. Secondary mania following traumatic brain injury. The American journal of psychiatry, 1993.PMID 8494069
- [8]Orlovska S, Pedersen MS, Benros ME, et al. Head injury as risk factor for psychiatric disorders: a nationwide register-based follow-up study of 113,906 persons with head injury. The American journal of psychiatry, 2014.PMID 24322397