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Psychiatric Disorders in Children and Adolescents in the First Six Months After Mild Traumatic Brain Injury
Jeffrey E. Max, M.B.B.Ch; Russell J. Schachar, M.D.; Julie Landis, Ph.D.; Erin D. Bigler, Ph.D.; Elisabeth A. Wilde, Ph.D.; Ann E. Saunders, M.D.; Linda Ewing-Cobbs, Ph.D.; Sandra B. Chapman, Ph.D.; Maureen Dennis, Ph.D.; Gerri Hanten, Ph.D.; Harvey S. Levin, Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:187-197. doi:10.1176/appi.neuropsych.12010011
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This study was supported by National institute of Mental health (NIMH) Grant K-08 MH01800 (Dr. Max) and National Institute of Neurological Disorders and Stroke (NINDS) Grant NS-21889 (Dr. Levin).

Disclosures: Dr. Schachar is a consultant for Eli Lilly Corporation and Purdue Pharma (Canada). None of the other authors has financial disclosures to make relative to for-profit enterprises.

From the Dept. of Psychiatry, Rady Children’s Hospital and, Univ. of California San Diego, San Diego, CA (JEM); Dept. of Psychiatry (RJS), Dept. of Psychology (MD), Hospital for Sick Children, Toronto, Ontario, Canada; Dept. of Psychology, Brigham Young Univ., Provo UT (EDB); Dept. of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX (EAW, GH, HL); Dept. of Psychiatry (AS), Dept. of Pediatrics (LE-C), Univ. of Texas Health Sciences Center, Houston, TX; Center for BrainHealth, Univ. of Texas, Dallas, TX (SC).

Send correspondence to Jeffrey E. Max, M.B.B.Ch; Rady Children’s Hospital, San Diego, CA; e-mail: jmax@ucsd.edu

Copyright © 2013 American Psychiatric Association

Received January 16, 2012; Revised May 15, 2012; Accepted May 29, 2012.

Abstract

The objective was to assess the nature, rate, predictive factors, and neurocognitive correlates of novel psychiatric disorders (NPD) after mild traumatic brain injury (MTBI). Children age 5–14 years with MTBI (N=87) from consecutive admissions to five trauma centers were enrolled and studied with semistructured psychiatric interviews soon after injury (baseline), and 70 of these children were assessed again 6 months post-injury. Injury severity; lesion characteristics; pre-injury variables, including psychiatric disorder, family psychiatric history, family functioning, socioeconomic status, psychosocial adversity, and adaptive functioning; and post-injury neurocognitive and adaptive functioning measures were assessed with standardized instruments. NPD occurred in 25 of 70 participants (36%) in the first 6 months after injury. NPD at 6 months was predicted by the presence of frontal white-matter lesions on MRI at 3 months post-injury, and was associated with concurrent decrements on neurocognitive indices of processing speed, expressive language, and intellectual functioning. NPD was not predicted by other indices of severity, pre-injury psychosocial variables, estimated pre-injury academic functioning, or adaptive and executive function decrements 6 months post-injury. These findings suggest that short-term psychiatric morbidity associated with MTBI in children and adolescents may be more common than previously thought and may have readily identifiable neuroimaging and neurocognitive correlates.

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TABLE 1.Demographic, Psychosocial, and Injury Data of a Mild Traumatic Brain Injury (TBI) Cohort (N=87)
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SD: standard deviation; GCS: Glasgow Coma Scale.

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TABLE 2.Lesion Distribution, Based on Research MRI: Entire Cohort (N=73) and in Children With and Without Novel Psychiatric Disorder (NPD) in the First 6 Months After Injury
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White-matter lesions were recorded specifically only in the frontal lobes.

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TABLE 3.Pre-Injury and Injury Correlates of Novel Psychiatric Disorder (NPD) in the 6 Months After Mild TBI
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None of the analyses reached statistical significance. Values are expressed as mean (standard deviation) except where indicated.

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GCS: Glasgow Coma Scale.

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TABLE 4.Neurocognitive Correlates of Novel Psychiatric Disorders (NPD) in the 6 Months After Mild Traumatic Brain Injury (MTBI)
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Values are expressed as mean (standard deviation).

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ABC: Adaptive Behavior Composite; CELF: Clinical Evaluation of Language Fundamentals; NS: not significant; WASI: Wechsler Abbreviated Scale of Intelligence; WISC: Wechsler Intelligence Scale for Children; WJ–R: Woodcock-Johnson–Revised.

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