Post Traumatic Stress Disorder (PTSD) and major depression are common, and often enduring, consequences of major trauma. While Traumatic Brain Injury (TBI) may protect against PTSD, major depression is even more common than after non-brain injury, and other psychological consequences are more diverse and frequently pervasive.
Both multiplicity of psychological disturbances and their interaction with physical injuries cumulatively worsen functioning and require comprehensive diagnosis and multidisciplinary therapy.
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PRACTICE POINT Both the newly designated condition Acute Stress Disorder and phobic anxiety in motor vehicles are commoner MVA consequences than Post Traumatic Stress Disorder |
Post Traumatic Stress Disorder (PTSD) and major depression are common, and often enduring, consequences of major trauma.
About 1 in 8 victims develop Acute Stress Disorder (ASD) 1, a newly designated precursor to Post Traumatic Stress Disorder (PTSD), which occurs in 10% of injury accidents.
This 1 in 10 rate for occurrence of PTSD changes little over the 5 years following injury accident 2, for new cases develop while others recover. 25% of those injured in motor vehicle accidents also suffer from long-term phobic anxiety as driver or passenger 2.
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PRACTICE POINT After Traumatic Brain Injury, PTSD is usually less severe but depression is even more common than after non-brain trauma |
While Traumatic Brain Injury (TBI) may protect against PTSD, major depression is even more common than after non-brain injury, and other psychological consequences are more diverse and frequently pervasive. It has previously been argued that PTSD and (even Mild) Traumatic Brain Injury (MTBI) should not co-exist , because even brief amnesia for the accident protects against such psychological injury.
However, there may be "islands" or "windows" of lucidity during the period of impaired consciousness which is a necessary criterion for the diagnosis of TBI. Nevertheless, a new study of MVA patients confirmed that TBI patients with PTSD reported less fear and helplessness than non-TBI.
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PRACTICE POINT All clients with continuing post traumatic disability should be psychiatrically screened for hitherto undiagnosed psychological injury |
Conversely, overall psychiatric disorder is more prevalent and varied 3 after even Mild TBI.
I have previously summarised 4 the common and diverse effects of TBI on sexual functioning. While personality change and diminished desire may have their greatest effect on the partner, loss of inhibition or empathy can have a pervasive effect on a wide range of interpersonal relationships.
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PRACTICE POINT Changes in sexual behaviour and functioning after MTBI cause far-reaching social disability which is frequently underestimated |
In a prospective study 5, 1 out of every 5 trauma survivors suffered major depression at a month, and three-quarters had not recovered by 4 months.
A Welsh accident involving a motor coach carrying psychiatric patients provided a rare opportunity to study 6 the influence of pre-existing psychological "thin skull". As might be expected, longstanding patterns anxiety and depression predisposed to similar post-traumatic responses, but other illnesses, for example chronic schizophrenia, had no effect. Similarly, personality traits did not predict response to neck strain 7.
Both multiplicity of psychological disturbances and their interaction with physical injuries cumulatively worsen functioning and require comprehensive diagnosis and multidisciplinary therapy. Just as major depression and PTSD are independent conditions 5 which may co-exist following trauma 8 and amplify one another, so psychological and physical injuries commonly exacerbate one another 9.
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