Neuropsychiatric Manifestations in Traumatic Brain Injury

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality. In these patients, cognitive, mood, and emotional disturbances are commonly observed, including depression, anxiety, mania, psychosis, and anger/aggression. The debilitating effect of TBI extends years after the initial injury and impairs the recovery process and patients’ quality of life. Compared to other major neurological diseases such as stroke or degenerative diseases, TBI occurs relatively young. Therefore, patients have to endure the sequelae for a more extended period. Therefore, proper diagnosis and treatment of the cognitive–emotional symptoms are essential. Studies have been made to seek the pathogenesis of the cognitive and neuropsychiatric symptoms. Unfortunately, these emotional disturbances are not apparent and often unnoticed by busy clinicians. Their phenomenology, predicting factors, and pathophysiology have been underrecognized and understudied. In addition, well-designed clinical trials regarding these symptoms are rare. It has been suggested that the congitive and emotional sequelae are related to the “remote” effect of the initial brain injury rather than the initial pathology itself. This review will describe some of the most common or relevant poststroke mood and emotional disturbances. The phenomenology, factors or predictors, and relevant lesion locations will be described, and pharmacological treatment of these emotional disturbances will be discussed based on presumable pathophysiological mechanisms.