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CLINICAL SYNTHESIS   |    
Clinical Considerations in the Evaluation and Management of Patients Following Traumatic Brain Injury
Henry J. Orff, Ph.D.; Chelsea C. Hays; Ashlee A. Heldreth, B.A., B.S.; Murray B. Stein, M.D., M.P.H.; Elizabeth W. Twamley, Ph.D.
FOCUS 2013;11:328-340. doi:10.1176/appi.focus.11.3.328
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Author Information and CME Disclosure

Henry J. Orff, Ph.D., Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System; and Department of Psychiatry, University of California, San Diego

Chelsea C. Hays, Research Service, VA San Diego Healthcare System

Ashlee A. Heldreth, B.A., B.S., School of Speech, Language, and Hearing Sciences, San Diego State University

Murray B. Stein, M.D., M.P.H., Department of Psychiatry, University of California, San Diego; Department of Family and Preventive Medicine, University of California, San Diego; and Psychiatry Service, VA San Diego Healthcare System

Elizabeth W. Twamley, Ph.D., Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System; Psychiatry Service, VA San Diego Healthcare System; Department of Psychiatry, University of California, San Diego

All authors report no competing interests.

The authors acknowledge grant support from the VA Rehabilitation Research and Development Service (D7217-R to EWT) and the Department of Defense (W81XWH-08-2-0159, INTRuST Clinical Consortium, to MBS).

Address correspondence to Henry J. Orff, Ph.D., VA San Diego Healthcare System, 9151B 3350 La Jolla Village Dr., San Diego, CA 92161; e-mail: horff@ucsd.edu

Abstract

Traumatic brain injury (TBI) is one of the most common causes of injury and disability, affecting about 1.7 million individuals annually in the U.S. Furthermore, TBI is also recognized as the “signature wound” for military personnel in recent wars. Both civilian and military TBIs result in individual, family, and societal economic and health costs. Even mild TBIs (i.e., concussions) can produce persistent difficulties in mental and physical well-being (e.g., problems with sleep, fatigue, pain, and cognitive functioning), which may be compounded by psychiatric comorbidities. Current treatment and management of the TBI patient typically involves case-by-case use of pharmacologic and/or cognitive-behavioral approaches that individually address post-TBI symptoms. We review the current literature on TBI diagnosis and treatment strategies and note areas where clinical controversies exist. It is hoped that through continued research (and discussion) of these important issues, a greater consensus on the science of treatment of TBI will be achieved.

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Figure 1. Traditional Interpretation and Revised Model of Relationship Between mTBI and Development of Postconcussive Symptomsa

aThe revised model emphasizes the role of psychiatric illness in the onset and maintenance of symptoms except for pain (adapted from Hoge et al., 2008 [145]).

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Table 1.Traumatic Brain Injury Severity Criteriaa
Table Footer Note

aAdapted from VA/DoD Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain injury (117).

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Table 2.Concussion Definitions
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Table 3.Concussion Rating Scalesa
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aLOC=Loss of consciousness; PTA=Posttraumatic amnesia

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Table 4.Pharmacologic Treatments for TBI Sequelae
Table Footer Note

Note. Table adapted from Talsky et al, 2000 (115)

+

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