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STANLEY L. GOODMAN, M.D. – Qualified Medical Examiner #962948

Diplomate, American Board of Psychiatry & Neurology

in Forensic, Child, Adolescent, Adult, Addiction, and Geriatric Psychiatry

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Review of Neuropsychiatric Aspects of Traumatic Brain Injury

In the Textbook of Neuropsychiatry, which is the definitive textbook in the field, there is a

Table giving a summary of Post-Concussive Syndrome in which the following symptoms

are present:1


Somatic Symptoms

1. Headaches

2. Fatigue

3. Insomnia

Cognitive Symptoms

1. Memory difficulties

2. Impaired concentration

Perceptual Symptoms

1. Sensitivity to noise

2. Sensitivity to light

Emotional Symptoms

1. Depression

2. Anxiety

3. Instability


Perceptual Symptoms

The clinical findings in Traumatic Brain Injury depend on which area of the brain

is damaged. Traumatic Brain Injury can cause most major psychiatric disorders:

1. Mood or Affective Disorders.

2. Psychotic Disorder.

3. Personality Disorder. There are three types of personality change which may occur:

(1) Apathetic type; (2) Disinhibited type; and (3) Mixed type. (Note: In the DSM-IV,

this would be "Personality Change Secondary to a General Medical Condition"

(310.1), in this case, the head trauma.)

4. Impulse Disorders. These disorders occur especially if the head injury is sustained

to the pre-frontal cortex.

Posttraumatic brain injury produces Post-Concussive Syndrome resulting in the following

clinical symptomatology:

1. Mood of Affective Depressive Disorders.

2. Psychotic Disorder.

3. Anxiety Disorder.

Since the frontal cortex is involved in executive functioning, frontal hypometabolism

results in a frontal lobe syndrome resulting in the patient complaining of apathy and lack of

motivation which significantly impairs cognitive performance. In addition, there

are numerous alterations in the main neurotransmitters in the brain which include

dopamine, norepinephrine, serotonin and acetylcholine.

1. Textbook of Neuropsychiatry by Jonathan M. Silver, M.D., Robert E. Hales, M.D., Stuart C. Yudofsky, M.D., "Neuropsychiatric Aspects of Traumatic Brain Injury" Table 1112, Page 35. American Psychiatric Association Press, June 1997.

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