TBI & Psychiatry: Facts

Traumatic Brain Injury (TBI) & Psychiatry: Facts


* Do not use anticonvulsants for seizure prophylaxis after the first week of TBI.
* Phenytoin and carbamazepine compared in patients recovering from TBI: both negatively affected cognition (motor and speed performance).


* Characteristic Features of Neuroaggressive Disorder:
- Reactive (Triggered by modest or trivial stimuli)
- Nonreflective (Usually does not involve premediation or planning)
- Nonpurposeful (Aggression serves no obvious long-term aims or goals)
- Explosive (Buildup is NOT gradual)
- Periodic (Brief outbursts of rage and aggression; punctuated by long periods of relative calm)
- Ego-dystonic (After outbursts patients are upset, concerned, embarrassed: as opposed to blaming others or justifying behavior)


* AEDs, Atypical antipsychotics and Benzodiazepines exacerbate cognitive deficits & impede recovery after TBI (Avoid where possible)


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* Do not use anticonvulsants for seizure prophylaxis after the first week of TBI.
Source: Report of the Quality Standards Subcommittee of the American Academy of Neurology, 2003

* Phenytoin and carbamazepine compared in patients recovering from TBI: both negatively affected cognition (motor and speed performance).
Source: Arch Neurol. 1994;51(7):653-660.
Link: http://archneur.jamanetwork.com/article.aspx?articleid=592944

Link: http://www.guideline.gov/content.aspx?id=43752

Anticonvulsant treatment may be used to prevent early post-traumatic seizures in the high-risk individual and are usually administered for one week in those with intracranial hemorrhage.
Prevention of early seizures has no statistically significant impact on long-term outcome or the development of late seizures or chronic epilepsy. Prevention of early seizures is reasonable to reduce seizure-associated complications during acute management.
Prophylactic anticonvulsants should not be used routinely after the first week unless other clinical indicators warrant their use, such as brain penetration, excessive intraparenchymal bleeding, or others.

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