Disturbances of neurovegetative functioning following TBI

In this chapter I will examine disorders of neurovegetative functioning in the form of the disorders of eating and sleeping, pain, and substance-use issues associated with the injury. Many of these processes are mediated by the deep mesencephalic regions of the brain and, as a result, are much less accessible to the usual behavioural and psychological probes used to investigate changes in the more eloquent regions of the brain. Neuropathological investigations of patients who have died from...

Lesion location and mechanism of secondary anxiety disorders

Grafman, Vance, Weingartner, Salazar, and Amin (1986) conducted a study of 52 veterans who suffered penetrating missile wounds that caused damage to the orbito-frontal cortex during the Vietnam War. Grafman et al. found that the patients with left-sided or bilateral wounds showed no differences in mood states when compared with the control participants. However, patients who had right-sided orbitofrontal lesions initially manifested anger that later gave way to panic, lassitude, general...

Disorders of sleeping

Sleep and wakefulness are two opposite states that compete with each other for the control of consciousness. Wakefulness is maintained by the reticular activating system (RAS) assisted by the activity of the catecholaminergic and cholinergic transmitter systems that convey the activation of the RAS via the thalamus to the cortex. Sleep is promoted by the activity of the dorsal raphe, which acts in accord with other brain stem nuclei to deactivate the RAS. Serotonergic neurons dampen down...

Evolution of the secondary psychosis following TBI

The duration of the period following the injury that results in the emergence of a posttraumatic psychosis has been reported throughout the literature and can last as little as one month (Levine & Finkelstein, 1982), 12 months (Delahunty, Morice, Frost, & Lambert, 1991), three years (Barnhill & Gaultieri, 1989 Filley & Jarvis, 1987), 10 years (Barnhill & Gaultieri, 1989) or more (i.e., 11 years Levine & Finkelstein, 1982). Slater, Beard and Glithero (1963) also noted a...

A biopsychosocial model of response to TBI

There is now almost universal agreement in the area of psychiatry that the biopsychosocial model of psychopathology is one of the most effective ways to characterise the diverse features of these disorders (Dilts, 2001). This model was originally proposed by George Engel in the early 1980s (Engel, 1980), and its principal theoretical position is that all illnesses have biological, psychological, and social causes. The biological model of mental illness proposes that mental illness is caused by...

Neardeath experiences NDEs

One aspect of survival of TBI that has not been discussed to any great extent in the literature is the degree to which survival following a serious injury may constitute an NDE. People who have been faced with an unavoidable outcome of death, but through some means have avoided this outcome, have reported NDEs (Stevenson & Greyson, 1979). Each NDE is comprised of a set of unique and a set of common elements. The commonly described elements include feeling out of the body, feeling of passing...

References

Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder A quantitative review. Journal of Consulting and Clinical Psychology, 65(1), 44-52. Abramson, L.Y., Alloy, L.B., & Metalsky, G.I. (1988). The cognitive diathesis-stress theories of depression Toward an adequate evaluation of the theories' validities. In L.B. Alloy (Ed.), Cognitive processes in depression. New York Guilford. Achte, K.A., Hillbom, E., & Aalberg, V....

Nosology

At the outset it is useful to draw a distinction between injury-related issues and those effects that occur as a consequence of the injury. So in the case of our list of entities detailed above, mild head trauma, mild traumatic brain injury, traumatic brain injury, and closed head injury would be considered injury-related descriptors. These should specify the nature of the injury that the individual has sustained (e.g., a blow to the head that resulted in a posttraumatic amnesia of one hour and...

Phenomenology and nosology of secondary psychotic disorders

The DSM-IV-TR (APA, 2000) classifies posttraumatic psychosis as a psychotic disorder due to a general medical condition (i.e., concussion or cerebral contusion), which can occur either with delusions (293.81) or with hallucinations (293.82). The Manual states Although there are no infallible guidelines for determining whether the relationship between the psychotic disturbance and the general medical condition is etiological, several considerations provide some guidance in this area. One...

Pain following TBI

Inevitably the same traumas that result in brain injury also often result in other forms of physical injury. These two sites of injury can and often do co-exist and, as a result, the impact of pain-related phenomena in tandem with TBI can culminate in chronic pain states compounding cognitive dysfunction, emotional well-being, and functional capacity (Bohnen & Jolles, 1992). The International Association for the Study of Pain (Merskey & Bogduk, 1994, p. 209) defines pain as an unpleasant...

PCS Organic or functional

In the history of psychiatry the lack of any obvious neuropathological signature of these disorders has resulted in years of delay and imprecise interpretations of these disorders that have their clearest manifestation in the use of the term functional disorder. A functional disorder is one for which there is overtly no organic cause. So, for example, epilepsy, Parkinson's disease, or an astrocytoma might be considered suitable organic causes for brain impairment. On the other hand,...

Reality distortion following TBI

Psychosis, denial, and deficits in the social perception of emotion In the next two chapters, I will embark on an unusual approach to the issues of postaccident behavioural and emotional disorders and concentrate on the issue of reality distortion following TBI. The distortion of reality can take a number of forms outlined in the design matrix below Schizophrenia or post-traumatic psychosis Somatoform disorder, factitious disorder or malingering Denial of deficit and impairment in the social...

M

McAllister, T.W., 28, 34, 35 McAllister-Williams, R.H., 114 McClelland, R.J., 43 McCracken, L.M., 39 McDonald, S., 131, 133-134 McKenzie, T.B., 101 McKinlay, W.W., 132 MacLean, P.D., 172 MacMillan, P.J., 198 McMillan, T.M., 77-78, 82, 83, 144 McNaughton, N., 90 Magnetic resonance imaging (MRI) for postinjury outcome, 30 posttraumatic psychosis, 125, 129, 130 Malingering, 140, 142 assessment, 148-153 criteria, 145-148 differential diagnosis, 143, 146 euphemisms for, 153 history of, 145...

Phenomenology and nosology of the secondary anxiety disorders

Anxiety consists of apprehension, tension, and undue concerns about a perceived danger. It is usually accompanied by signs associated with the activation of the sympathetic nervous system and is described as free-floating anxiety when there is no conscious recognition of the specific threat. Anxiety is regarded as the chief characteristic of all of the neurotic disorders, and can be differentiated from normal or adaptive fear in that (1) it is not related to a perceived realistic threat or at...

Duration of posttraumatic amnesia PTA

PTA has been defined as the period of loss of memory following a traumatic event. Specifically, ongoing experience is not registered or the registration of that experience is not continuous (Russell & Smith, 1961). PTA duration is measured from the time of the injury and includes the disorientation, confusion, and coma periods and continues up to the point when the patient resumes continuous registration of experience (Schacter & Crovitz, 1977). Table 1.1 provides estimates of injury...

Lesion location and mechanism of sexual dysfunction

Despite the issues raised concerning the site of lesions in TBI and their effect on sexual functioning, there has been surprisingly little support for specificity of localisation in the literature evaluating individuals subsequent to injury. This issue is necessarily confounded by the relatively diffuse nature of traumatic brain injury in its effect on the brain, and in the poor ability for older forms of imaging technology including CT, SPECT, and the earlier generation positron emission...