The spectrum of emotional distress and personality changes after minor head injury incurred in a motor vehicle accident.

This is a systematic presentation of the emotional and personality disorders of 33 patients who incurred minor traumatic brain injury (MTBI) in a vehicular accident. A wide spectrum of disorders was observed: cerebral personality disorder, persistent altered consciousness, post-traumatic stress, psychodynamic reactions to impairment, and complex reactions expressing neurological, somatic, and psychological dysfunctions (sexuality and somatization). Examples of each category are offered to aid identification. A total of 31/33 patients suffered an additional psychiatric disorder. Unreported head trauma and loss of consciousness (LOC) elicited by detailed interviews helped to explain the extent of impairment. Emotional disorders, added to persistent cognitive loss and other neuropsychological symptoms, greatly impair the capacity to adapt after traumatic brain injury (TBI). Clinical procedures (interview; Rorschach; observation; figure drawings; checklists) are recommended to obtain detailed personality information needed for diagnosis, prognosis, and treatment. Behavioural outcome after TBI reflects disturbance in the processing of internal and external stimulation, and disturbance of pre-existing physiological and psychological processes. Emotional distress consistent with the accident and impairment adds to the credibility of patient complaints. There is an interaction between lesion effects and various emotional disturbances, which impacts employment, social relationships, and the enjoyment of life. Prompt and sympathetic treatment will contribute to more effective treatment, and may be anticipated to reduce or prevent some persistent symptoms after minor head injury.