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Although many neurobehavioral disturbances appear to result directly from damage to the brain, the contributions of premorbid personality features, temperament, and antecedent psychiatric disturbances are also important in determining the nature of post-TBI psychiatric and behavioral syndromes, particularly in patients with mild to moderate brain injuries. In a review of mild TBI, Kibby and Long (1996) noted several preinjury factors that influence recovery: alcohol abuse, age, level of education, occupation, personality, emotional adjustment, and neuropsychiatric history (see Table 4–10). Premorbid anxiety, depression, psychosis, personality disorder, attention-deficit/hyperactivity disorder, and alcohol and/or substance abuse may significantly influence recovery from TBI. Individuals with certain personality disorders (antisocial and obsessive-compulsive) may experience greater post-TBI adjustment issues (Hibbard et al. 2000). Max et al. (1997) found that preinjury psychiatric history along with severity of injury and preinjury family function predicted the development of "novel" psychiatric disorders in children and adolescents during the second year postinjury. The presence of mental retardation or learning disabilities also may influence the presentation of TBI-associated neurobehavioral disturbances.

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Table Reference Number
Table 4–10. Preinjury factors that can influence recovery

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