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Psychiatric Sequelae of Severe Closed Head Injury

Severe closed head injury often results in physical, neuropsychologic, and psychiatric sequelae in the patient and in psychosocial disruption within the family. Because of the resulting deficits, the normal movement of the injured child toward increased independence is thwarted, and he or she often moves back to a state of increased dependency. The spectrum of sequelae may be mild to severe and includes almost the full range of child and adolescent psychopathology, perhaps because one of the most common and striking sequela is enhancement of previously existing disturbances. A syndrome of behavioral disinhibition is a disorder unique to this population.

The psychiatric sequelae often appear as the physical and cognitive status improves in the year following injury, and they may eventually dominate the clinical picture.

Duration of coma and of posttraumtic amnesia are measures of global brain dysfunction and are the best indicators of overall prognosis.

Many child and adolescent patients with sequelae of severe closed head injuries have had histories of psychiatric on behavioral disorders or drug or alcohol abuse prior to their injury. Posttraumatic psychiatric sequelae consist of the same behavioral and psychiatric disorders that affect children or adolescents who have not had head injuries.

Standard treatment methods for similar on other diagnostic entities are being tailored to the needs of children and adolescents with severe closed head injury. Medications are currently being used to control symptoms of aggression, agitation, and impairment of memory. Because of the integral involvement of the family in the recovery process, psychosocial intervention must be an important component of any treatment program.

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