Psychiatric Sequelae of Head Injuries

Volume 6 Issue 3 March 2016

Consultation Liaison Psychiatry Focus: ‘Neurosurgery’

Head injury is an important public health problem these days. It is a big burden on our economy as majority of the patients are from young earning age-group and the cost involved in the treatment of these patients is quite high. Significant numbers of these injuries occur when the driver is under influence of alcohol or other inebriant drugs.

Actual incidence of head injury in India is not known, as we do not have any nationwide registry. The incidence of head injury is increasing due to increasing urbanization and increasing number of vehicles. Many patients who come to trauma centers with severe head injury have sustained injuries under the influence of alcohol or other drugs of abuse. The outcome of head injury is very dismal, with a reported good outcome in just 28% of patients. The mortality rate is about 22%, and about 19% of patients remaining vegetative.

Head injury can result in hematomas (extradural, subdural or intraparenchymal), bony fractures (depressed or compound) or diffuse axonal injury. Hematomas can be removed surgically, but there is yet no treatment available for diffuse axonal injury. Diffuse axonal injury might be the cause of various neurological deficits and disability, which are commonly seen in patients following head injury, even in patients who were treated successfully for hematomas.

Psychiatric sequelae of head injuries include changes in personality, occurrence of mood episodes, cognitive deficits, and even psychosis. It is difficult to determine the course and outcome of such psychiatric symptoms, but sometimes, the deficits and personality changes are stable. Behavioral changes like irritability, aggression are encountered, which might need psychiatric management in the form of medications and behavioral measures. Thus there is a need for liaison with the psychiatrists after the neurosurgical interventions have been conducted, preferably in a multi-disciplinary setting so that the behavioral issues after head injury are addressed effectively. Thorough evaluation, timely intervention, and holistic management is very important to prevent disability and regaining functionality of body and mind.

This is just to highlight the need to prevent head injury as despite best of treatment the morbidity and mortality is still very high. Driving under the influence of inebriant drugs should be avoided in all circumstances and traffic rules should be strictly enforced. Let’s call for road safety. Join hands to help each other, as together we can make a difference.