THE SPECTRUM OF EMOTIONAL DISTRESS AND PERSONALITY CHANGES AFTER MINOR HEAD-INJURY INCURRED IN A MOTOR-VEHICLE ACCIDENT

This is a systematic presentation of the emotional and personality dis orders of 33 patients who incurred minor traumatic brain injury (MTBI) in a vehicular accident. A wide spectrum of disorders was observed: c erebral personality disorder, persistent altered consciousness, post-t raumatic stress, psychodynamic reactions to impairment, and complex re actions expressing neurological, somatic, and psychological dysfunctio ns (sexuality and somatization). Examples of each category are offered to aid identification. A total of 31/33 patients suffered an addition al psychiatric disorder. Unreported head trauma and loss of consciousn ess (LOC) elicited by detailed interviews helped to explain the extent of impairment. Emotional disorders, added to persistent cognitive los s and other neuropsychological symptoms, greatly impair the capacity t o adapt after traumatic brain injury (TBI). Clinical procedures (inter view; Rorschach; observation; figure drawings; checklists) are recomme nded to obtain detailed personality information needed for diagnosis, prognosis, and treatment. Behavioural outcome after TBI reflects distu rbance in the processing of internal and external stimulation, and dis turbance of pre-existing physiological and psychological processes. Em otional distress consistent with the accident and impairment adds to t he credibility of patient complaints. There is an interaction between lesion effects and various emotional disturbances, which impacts emplo yment, social relationships, and the enjoyment of life. Prompt and sym pathetic treatment will contribute to more effective treatment, and ma y be anticipated to reduce or prevent some persistent symptoms after m inor head injury.