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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SYNOPSIS: NEUROPSYCHIATRIC ASPECTS OF TRAUMATIC BRAIN INJURY
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
1. Memory difficulties
2. Impaired concentration
1. Sensitivity to noise
2. Sensitivity to light
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
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.