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Psych Block 2 > TBI Sequelae > Flashcards

TBI Sequelae Flashcards

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1
Q

Define traumatic brain injury.

A

“Force” acting on the brain:
- Caused by impact to the head, or other events that cause rapid movement or displacement of the brain within the skull, for example, blast injuries

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2
Q

What are the results of TBI?

A
  • Disturbance in level of consciousness

- Loss of consciousness not required

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3
Q

Name 3 mechanism sof TBI?

A

1) Impact Forces: (contact with object)
2) Inertial Forces: (acceleration or deceleration of the brain)
3) Blast Forces

*Coup/contre coup site is common

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4
Q

What are the neurovascular/neuro disturbances that can occur post TBI?

A
  • Subdural Hematoma
  • Shear hemmorage
  • DAI
  • Contusion
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5
Q

What are the areas that are more commonly affected by Diffuse axonal injury?

A

1) Sub-cortical white matter

2) Corpus callosum

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6
Q

Describe the injury sequence of DAI (Diffuse Axonal Injury).

A

Injury Sequence:

  • Axon is stretched
  • Increased permeability
  • Calcium influx
  • Damage to cytoskeleton
  • Impaired axoplasmic transport
  • Axonal swelling
  • Detachment and axonal death
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7
Q

What secondary injuries are associated with TBI?

A
  • Massive release of neurotransmitters
  • Cerebral edema/ischemia/hypoxia
  • Increased intracranial pressure
  • Subsequent triggering of excitotoxic injury cascades
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8
Q

What neurochemical disturbances can occur post TBI?

A

Cholinergic
Catecholaminergic
Glutamatergic
Serotonergic

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9
Q

What are the measures of severity for TBI?

A
  • Loss of consciousness
  • Duration of post traumatic amnesia
  • Glasgow Coma Scale score
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10
Q

How severe are most TBI?

A

70-80% are “mild”

- Mild with major sequelae

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11
Q

What is the Glasgow Outcome Scale Score?

A

The ‘Glasgow Outcome Score’ (GOS) is a scale so that patients with brain injuries, such as cerebral traumas can be divided into groups that allow standardised descriptions of the objective degree of recovery.

*It is NOT a marker of severity for TBI

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12
Q

What are the major causes of TBI (4)?

A

1) Falls (most common) => Elderly (and very young)
2) Motor vehicle accidents => Teens and young adults
3) Sports Injuries => Youth-Adult
4) Assaults => Urban populations

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13
Q

Describe the prevalence of TBI.

A

Gender: TBI occurs twice as often in men as in women.

Age:

  • Children below age 4
  • Individuals between the ages of 15 and 24 years
  • Individuals age 75 and older
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14
Q

What is implicated in nearly HALF of TBI cases?

A

Alcohol

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15
Q

What (childhood) disorder is associated with TBI?

A

ADHD

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16
Q

What are the physical symptoms of TBI?

A 
Seizures
Headaches
Dizziness
Balance and coordination problems
Visual disturbances
Hearing impairments
Weakness or paralysis
Sensory impairments
17
Q

What are the cognitive impairments of TBI?

A

Impaired attention
Memory
Language skills
Complex cognition (judgment, insight, problem solving)

18
Q

What are the emotional/behavior symptoms of TBI?

A 
Depression
Anxiety
Mania
Irritability
Affective lability
Rage/aggression
Psychosis (rare) 
Diminished motivation (apathy)
Impulsivity
Perseveration
19
Q

What type (broadly) of disorder do nearly half of TBI patients incur?

A

Almost half of individuals who sustain a TBI will develop a neuropsychiatric disorder

20
Q

What cognitive domains are MOST impacted by mild TBI?

[ Dysexecutive syndrome]

A
  • Social Cognition (Social comportment)
    • Lateral orbitofrontal
  • Complex Attention (Motivation)
    • Anterior cingulate
  • Learning/memory (Executive)
    • Dorsolateral prefrontal
21
Q

What are the symptoms associated with Lateral Orbitofrontal Circuit dysfunction?
[Social Comportment]

A

Impulsivity
Irritability
Affective Instability
Awareness deficits

22
Q

What are the symptoms associated with Anterior Cingulate and Medial Frontal Circuit dysfunction?
[Motivation]

A

Apathy:

  • Loss of interest
  • Loss of initiative
  • Loss of drive
23
Q

What is the prevalence of developing an axis I disorder post TBI?

A 
48% developed Axis I Disorder after TBI
  [ - 28% depression
   - 12% alcohol abuse/dependence
   - 8% panic disorder
   - 8% phobic disorder
   - 7% psychotic disorder]
24
Q

What are the cognitive/executive deficits after TBI?

A 
Executive Function
Attention
Memory
Speed of Information Processing
Speech and language
25
Q

What are the symptoms associated with Dorsolateral Prefrontal Circuit dysfunction?

A

Planning
Set-shifting
Problem solving
Working memory

26
Q

How is TBI classified in DSM 5?

A 
Neurocognitive disorder (formerly dementia-new term expands to younger patients)
   - Can be mild or major
27
Q

What domain is least likely to be affected by TBI?

[complex attention, executive function, learning/memory, language, perceptual motor ability, social cognition]

A

Perceptual Motor Ability

28
Q

What criteria must a disorder meet in order to be considered “due to” TBI?

A

1) Neurocognitive disorder must present either:
-immediately after the brain injury occurs
OR
- immediately after the individual recovers consciousness after the injury

                            AND 2) Must persist past the acute post-injury period
29
Q

How do we understand the personality disorder associated with TBI?

A

NOT Cluster A-C

  • Considered “personality change due to another medical condition”*
30
Q

What are the most promising pharmaceuticals for TBI?

A
  • The most promising of these approaches are “multipotential,” targeting at least two or more secondary-stage injury mechanisms.
  • They have potential to modulate one or more of these multiple secondary injury factors, providing a great chance of achieving clinical value.
    • Statins
    • Cyclosporine
31
Q

What drugs are available for TBI related cognitive symptoms?

A

Efficacy has been reported for use of cognitive enhancers: methylphenidate, amantadine, galantamine, donepezil, modafinil

32
Q

What drugs are available for TBI related depression symptoms?

A

Depression: Medications often prescribed include citalopram, amitriptyline, paroxetine and sertraline.

33
Q

What drugs are available for TBI related emotional changes?

A

Antipsychotic medications are used

- quetiapine

34
Q

What drugs are available for TBI related seizures?

A

sodium valproate, neurontin, topiramate and carbamazepine

35
Q

What are the drug management guidelines for TBI drugs?

A

1) Start with low dosages
2) Titrate more slowly
3) Stop drugs sooner

Psych Block 2 (22 decks)

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