Management of Adults With Traumatic Brain Injury

Traumatic brain injury (TBI) is a common and serious medical problem experienced across the lifespan that is associated with a large amount of neuropsychiatric comorbidity. Psychiatrists frequently see these patients for consequent cognitive, mood, and behavioral disturbances. Because TBI has received the most attention within the last decade due to heightened awareness and ascertainment, many practicing psychiatrists may not have received adequate training in the assessment and treatment of patients with TBI.

Management of Adults With Traumatic Brain Injury is a readily accessible clinical guide for psychiatrists who treat patients with TBI. As mentioned within the text, the study of TBI has grown exponentially within the last decade, resulting in a vast and dispersed literature that may not be convenient for the busy clinician to review. Fortunately, this guide does an excellent job of condensing research results, guidelines, and standards of care that are of enormous practical value for practicing psychiatrists. The text confines itself to the clinical care of TBI patients and provides adequate reference to more basic science aspects of these disorders should the reader be interested in pursuing them.

The text is broken into three general sections: assessment, management, and special topics. An introductory chapter provides an excellent overview of the pathophysiological mechanisms involved in TBI as they pertain to the clinical aspects outlined in later chapters. Because most psychiatrists treat patients with mild TBI (also referred to as concussion), most of the discussion focuses on this population subset, with the exception of long-term complications and management of those with more severe TBI. A strength of the book is its demarcation of the management section according to neuropsychiatric syndromes, since this is often how patients present to psychiatrists (e.g., “Mr. X” is referred to you for depression following a mild TBI). This serves to make the text a practical guide in which data can be quickly looked up during or following a patient encounter, requiring a minimal amount of time. Management of all neuropsychiatric syndromes includes both pharmacological and nonpharmacological treatments in addition to preventative interventions. Somatic symptoms (e.g., vertigo, headache) that frequently accompany neuropsychiatric symptoms are also addressed in a way that is easily understood, and the authors provide the reader with knowledge on when and to whom patients with these symptoms should be referred. The special topics section mostly focuses on specific TBI populations, including the elderly, athletes, and military personnel. Also included within this section is a very informative, but simplified, guide to forensic issues that frequently surround treating a TBI patient. This chapter is written from the perspective of a treating physician, the most likely role of the reader.

The quality of the text is excellent. Classic TBI literature is included but is done in a way that supports more recent research and recommendations. As is often the case, controlled clinical studies may be lacking with regard to treating certain neuropsychiatric syndromes in TBI. In these cases, many of the authors give anecdotal reports and suggestions based on their own clinical practices. Most chapters are written by experts within the TBI field whose primary research and clinical foci are the topic of their chapter. Chapters are comprehensive, and pertinent references are often cited for more in-depth reading. The end of the book includes a list of websites for patients, caregivers, and clinicians that have up-to-date information and recommendations.

In conclusion, this text emphasizes the valid point that all psychiatrists will likely experience caring for a patient with TBI. The psychiatric subspecialties (e.g., child and adolescent psychiatry, geriatric psychiatry, addiction medicine, and psychosomatic medicine) may be more likely to encounter these patients given the increased risk for TBI in these populations. Although possibly a daunting task for clinicians who may not have encountered much TBI in their training, this text provides a comprehensive and practical approach for the assessment and management of these patients and emphasizes the very important point that psychiatrists have the potential to greatly increase the quality of life for these patients and their families.