Mood and behavioural disorders following traumatic brain injury: clinical evaluation and pharmacological management

• Published in: Brain injury Vol. 15; no. 2; pp. 139 - 148
• Main Author: Claudio Perino, Roberto Rago, Alessandro Cicolin, Riccardo Torta, Francesco Monaco
• Format: Journal Article Conference Proceeding
• Language: English
• Published: London Informa UK Ltd 01-02-2001; Taylor & Francis
• Subjects: Adult; Antidepressive Agents - administration & dosage; Antidepressive Agents - therapeutic use; Biological and medical sciences; Brain Injuries - diagnosis; Brain Injuries - psychology; Brief Psychiatric Rating Scale; Carbamazepine - administration & dosage; Carbamazepine - therapeutic use; Citalopram - administration & dosage; Citalopram - therapeutic use; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - etiology; Drug Therapy, Combination; Female; Glasgow Coma Scale; Humans; Male; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - drug therapy; Mental Disorders - etiology; Neuropharmacology; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Mood disorder; Heart; Human; Prognosis; Serotonin; Cardiovascular disease; Depression; Tricyclic compound; Reuptake inhibitor; Trauma; Carbamazepine; Citalopram; Behavioral disorder; Chemotherapy; Treatment; Mood stabilizer; Heart disease; Antidepressant agent; Complication; Evolution; Dibenzazepine derivatives
• ISSN: 0269-9052; 1362-301X
• DOI: 10.1080/02699050120891

In order to investigate pharmacotherapeutic responsiveness of major depression and other behavioural disturbances associated with traumatic brain injury (TBI), 20 post-TBI patients were diagnosed as being depressed by two independent neuropsychiatrist observers, out of 37 consecutive TBI subjects sent to psychiatric counselling for poor compliance during rehabilitation programmes or psychiatric/ behavioural disturbances after return to society. They were subsequently divided into two subgroups, depending on time elapsed from trauma (A: within 6 months; B: at 24-36 months post-trauma) and were enrolled in an open informed pharmachological study. Rating at baseline included Glasgow Coma Score on hospital admission, length of coma, length of hospitalization, Functional Independence Measure (FIM), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression scale (CGI). BPRS and CGI were repeated after 12 weeks of oral administration of citalopram (20mg a day) and carbamazepine (600mg a day). At baseline, psychiatric symptoms in group B were worse than in group A (particularly somatic overconcern, anxiety, depressed mood, psychomotor slowness, inappropriate and labile affect). At T1, the global (group A and B combined) CGI and BPRS scores showed a statistically significant improvement when compared with T0, even if group B scores remained higher than group A. The results of this study suggest that: (a) citalopram combined with carbamazepine is effective in reducing depression and behavioural disorders following TBI, and (b) these disturbances should be addressed as soon as possible during the acute rehabilitation period.