Bhumi Sharma, Khushi Jain
Traumatic Brain Injury (TBI) can lead to overwhelming and lasting effects on a person’s cognitive, behavioural, emotional and overall psychological functioning. Issues like memory loss, mood swings, aggressive behaviour and in some cases psychological disorders like major depressive disorder, anxiety disorder; are not that uncommon in people who have suffered from a TBI. Research in this field can provide us with a better understanding of the psychological effects of a physical injury and can help us build better interventions and treatments. It can also help in exploring the relationship between TBI and development of psychological disorders and delve deeper into neuropsychology. This article will talk about long-term cognitive, emotional, and behavioral outcomes of TBI; and the relationship between TBI and the development of psychiatric disorders.
The Multifaceted Impact of Traumatic Brain Injury on Mental Health
Traumatic brain injury (TBI) is the leading cause of disability in those aged under 40 years, commonly affecting young males injured in road traffic accidents. The injury interrupts the important developmental transition to independence and results in significant emotional distress (Ponsford et al. 1995). Clarification is also required concerning the contribution of pre-injury psychiatric history to post-injury disorders. The literature variously posits that preinjury disorders increase risk for post-injury disorder development (Deb et al. 1999; Ashman et al. 2004), that they are not significantly associated (Fann et al. 1995; Jorge et al. 2004), or that those without a pre-injury history have an increased risk of post-injury psychiatric disorder (Fann et al. 2004). Importantly, there are dramatic variations in reported incidence and prevalence rates between studies, with post-injury incidence of depression ranging from 15.3% to 33% and prevalence from 18.5% to 77% (Kim et al. 2007). Reported prevalence of anxiety disorder ranges between 19% (Rutherford et al. 1977) and 70% (Lewis, 1942).
Traumatic brain injury (TBI) is a critical condition that impacts individual cognitive functions (memory deficits, post-traumatic amnesia, and attention challenges), emotional stability (depression, anxiety, and PTSD), and behavioral functions (aggression, impulsivity, and social withdrawal).Historically, TBI has been linked to post-traumatic amnesia (PTA), a global cognitive disturbance characterized by confusion, disorientation, and difficulty in storing or retrieving new information. This stage often includes retrograde amnesia, significantly impacting patients’ ability to reintegrate into daily life (Halalmeh et al., 2023). Early studies on sports-related concussions identified that individuals with repeated concussions exhibit greater susceptibility to neuropsychological deficits and long-term cognitive impairments. Younger children, in particular, are at a higher risk of prolonged cognitive deficits, emphasizing age as a critical factor influencing recovery trajectories.
Recent advancements highlight virtual reality (VR)-based rehabilitation as a promising intervention. Semi-immersive VR has shown superior results in improving attention, memory, and executive functions compared to traditional methods, offering an engaging approach to cognitive recovery post-TBI (De Luca et al., 2019). However, significant gaps persist. Given the individual variability in TBI experiences, these findings may not be generalizable across diverse populations. Personalized rehabilitation plans tailored to individual needs remain underexplored.
However, future research must address the heterogeneity of TBI experiences to ensure equitable and effective interventions for all patients.
TBI and Psychological Disorders
Traumatic Brain Injury or TBI is when the brain suffers an injury from an external force and can range from mild to severe, which can even lead to death. The relationship between TBI and psychological disorders is intimate but complex. The interplay between neurological damage from TBI and the onset of psychiatric conditions is complex, and understanding this relationship is crucial for improving the treatment and outcomes for individuals affected by brain injuries. The most common consequences of TBI are psychological and psychosocial impairment and may result in a broad range of emotional and behavioural abnormalities. The most severe manifestation is in the form of psychological disorders. According to studies the frequency of psychiatric disorders in individuals is higher than in the general population and in individuals prior to injury. These suggest that the chance of mood and anxiety disorders to occur increases during the first year post injury.
Around 70% of people after suffering from a Traumatic Brain Injury exhibited Sleep-wake dysfunction. Post-mortem detailed evaluations of the brains of patients who did and did not suffer from TBI showed a significant reduction in hypocretin neurons which causes excessive daytime sleepiness.
Behavioral, Cognitive and Emotional Effects on TBI
Traumatic brain injuries extend far beyond physical damage, significantly impacting an individual’s daily functioning and overall quality of life. These effects are not limited to the individual but also influence their social environment and the people around them.This theme is vital as it sheds light on how various impairments such as memory loss, emotional instability, and social withdrawal, aggression, impulsivity undermines an individual’s independence and productivity. The complexity and uniqueness of each injury highlights the necessity for tailored interventions, as a standardized approach fails to accommodate the diverse challenges faced by TBI survivors. Understanding the multifaceted impacts of TBI is crucial for developing effective strategies to support individuals in regaining functionality and improving their quality of life, while also easing the burden on their caregivers and support systems. The interventions are necessary as the course of recovery for a TBI survivor can be lengthy and challenging both on the survivor and the caregiver as it requires proper care, timed medications, follow ups which can become a burdened in the caregiver’s life and it may result in emotional disturbances in caregivers such as anxiety or depression and its adverse effects may stay longer in their life. Hence tailored approaches, such as cognitive rehabilitation, psychotherapy, and structured support systems, help survivors regain independence while providing caregivers with the resources and coping strategies needed to manage their roles effectively. This holistic approach ensures better outcomes for both survivors and their support networks.
TBI in Military Personnel: Unique Cognitive and Emotional Challenges
Most studies presented previously describe TBI in civilian populations. However, given the high rates of TBI among veterans and military service members, it is crucial to understand how it affects their cognitive, emotional, and behavioral functions. The acute effects of mild TBI (mTBI) in military personnel have been well-documented. Similar to civilians, the most commonly reported post-concussive symptoms include headaches, dizziness, memory problems, balance issues, and irritability.(Andrea S. Vincent a et al., 2014)
The causes of injury differ significantly between civilians and military personnel, influencing their cognitive, emotional, and behavioral outcomes. For instance, civilians might sustain injuries from vehicular accidents, while military personnel often experience TBIs due to blasts, which can result in more diffuse brain damage which leads to dementia. Emotional symptoms such as post-traumatic stress disorder (PTSD) are significantly more common in military personnel due to their greater exposure to violence. This often impacts their functioning, leading to increased aggression and challenges in adjusting to civilian life after service.
The distinct contexts and stressors of military life create a unique symptom profile, highlighting the need for specialized interventions tailored to address combat-related trauma and its effects on cognitive, emotional, and behavioral health.
Understanding the Link Between Traumatic Brain Injury and Psychological Dysfunction
Traumatic brain injury, mild or severe, has the capacity to cause psychological dysfunction as reviewed in many studies. This shows that neurology, majorly the brain, has a role to play in the manifestation of psychological disorders. There is a definite relationship between Traumatic Brain Injury and psychological disorders but the current available data does not provide sufficient information to understand this relationship in detail. There is a need for more elaborate studies and research to be done focused on the neurology of psychological disorders and how TBI plays a role.
In summary, TBI is known to lead to transient or chronic effects on neurobehavioral and cognitive functioning, which vary according to severity, mechanics, and timing of injury. Hence, it is highly important to have a variety of interventions to ensure a broader scope for effective improvement and recovery.
References
Andrea S. Vincent a, a, b, & AbstractTraumatic brain injury (TBI) is recognized as an important risk factor for the long-term cognitive health of military personnel. (2014, June 10). Cognitive changes and dementia risk after traumatic brain injury: Implications for aging military personnel. Alzheimer’s & Dementia.
https://www.sciencedirect.com/science/article/pii/S1552526014001344#bib9
De Luca, R., Maggio, M. G., Maresca, G., Latella, D., Cannavò, A., Sciarrone, F., Lo Voi, E., Accorinti, M., Bramanti, P., & Calabrò, R. S. (2019a, July 30). Improving cognitive function after traumatic brain injury: A clinical trial on the potential use of semi-immersive virtual reality. Behavioural neurology. https://pmc.ncbi.nlm.nih.gov/articles/PMC6701422/
Devi, Y., Khan, S., Rana, P., Deepak 3, Dhandapani, M., Ghai, S., Gopichandran, L., & Dhandapani, S. (2020, October). Cognitive, behavioral, and functional impairments among traumatic brain injury survivors: Impact on caregiver burden. Journal of neurosciences in rural practice. https://pmc.ncbi.nlm.nih.gov/articles/PMC7595773/
Dia R. Halalmeh 1 2 3, 1, 2, 3, 4, & Traumatic brain injury (TBI) is a major public health concern. (2023a, December 15). The role of Neuropsychology in Traumatic Brain Injury: Comprehensive Literature Review. World Neurosurgery.
https://www.sciencedirect.com/science/article/pii/S1878875023017928
Intracranial pressure monitoring for traumatic brain injury in the modern https://www.researchgate.net/publication/40030500_Intracranial_pressure_monitoring_for_traumatic_brain_injury_in_the_modern_era
Morse, A. M., & Garner, D. R. (2018). Traumatic brain injury, sleep disorders, and psychiatric disorders: An underrecognized relationship. Medical Sciences, 6(1), 15.
https://doi.org/10.3390/medsci6010015
Rogers, J. M., & Read, C. A. (2007). Psychiatric comorbidity following traumatic brain injury. Brain Injury, 21(13–14), 1321–1333.
