Johns Hopkins Psychiatry Guide
Traumatic Brain Injury
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DEFINITION
- Traumatic brain injury (TBI) is most simply defined as damage to the brain from trauma to the head from a source outside of the brain.
- The Centers for Disease Control and Prevention (CDC) defines the cause of TBI as a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain (http://www.cdc.gov/traumaticbraininjury/).
- It is important to remember that not all blows or jolts to the head result in a TBI.
- Severity of TBI is rated at the time of injury/initial assessment as mild, moderate, or severe according to Glasgow Coma Scale (GSW), duration of loss of consciousness (LOC), and/or duration of posttraumatic amnesia (PTA) (see Table Severity of TBI)[1].
- Importantly, the severity rating of the TBI itself does not necessarily correspond to the severity of the resulting psychiatric phenomena.
Injury Characteristic | Mild TBI | Moderate TBI | Severe TBI |
Loss of consciousness (LOC) | < 30 minutes | 30 minutes - 24 hours | >24 hours |
Posttraumatic amnesia (PTA) | < 24 hours | 24 hours - 7 days | >7 days |
Disorientation and confusion at initial assessment (Gasgow Coma Scale Score) | 13-15 (not below 13 at 30 minutes) | 9-12 | 3-8 |
- Psychiatric disorders that may result from TBI are wide-ranging and include mood disturbances, psychosis, cognitive disturbances, and behavioral disturbances.
- Certain symptoms such as sleep disturbances, fatigue, apathy, and pathological laughter / crying may occur in isolation rather than as part of a psychiatric syndrome.
- Although as described below TBI can have a number of psychiatric sequalae, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) only includes cognitive impairment due to TBI, which is classified in the neurocognitive disorders (NCDs) section[1].
-- To view the remaining sections of this topic, please log in or purchase a subscription --
DEFINITION
- Traumatic brain injury (TBI) is most simply defined as damage to the brain from trauma to the head from a source outside of the brain.
- The Centers for Disease Control and Prevention (CDC) defines the cause of TBI as a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain (http://www.cdc.gov/traumaticbraininjury/).
- It is important to remember that not all blows or jolts to the head result in a TBI.
- Severity of TBI is rated at the time of injury/initial assessment as mild, moderate, or severe according to Glasgow Coma Scale (GSW), duration of loss of consciousness (LOC), and/or duration of posttraumatic amnesia (PTA) (see Table Severity of TBI)[1].
- Importantly, the severity rating of the TBI itself does not necessarily correspond to the severity of the resulting psychiatric phenomena.
Injury Characteristic | Mild TBI | Moderate TBI | Severe TBI |
Loss of consciousness (LOC) | < 30 minutes | 30 minutes - 24 hours | >24 hours |
Posttraumatic amnesia (PTA) | < 24 hours | 24 hours - 7 days | >7 days |
Disorientation and confusion at initial assessment (Gasgow Coma Scale Score) | 13-15 (not below 13 at 30 minutes) | 9-12 | 3-8 |
- Psychiatric disorders that may result from TBI are wide-ranging and include mood disturbances, psychosis, cognitive disturbances, and behavioral disturbances.
- Certain symptoms such as sleep disturbances, fatigue, apathy, and pathological laughter / crying may occur in isolation rather than as part of a psychiatric syndrome.
- Although as described below TBI can have a number of psychiatric sequalae, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) only includes cognitive impairment due to TBI, which is classified in the neurocognitive disorders (NCDs) section[1].
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