Organic personality disorder after traumatic brain injury: cognitive, anatomic and psychosocial factors. A 6 month follow-up.

OBJECTIVE: The purpose of the study is to describe psychosocial adjustment in patients who present Organic Personality Disorder (OPD) after TBI in relation to patients with TBI without OPD. METHOD: The group included patients who were admitted as inpatients in the Neurology Service. Exclusion criteria were: previous personality disorders; previous alcohol and drugs addiction, history of head injury and other neurological diseases. For this purpose, a semi-structured interview based on the ICD-10 was applied to the patient or significant other during the 1st or 2nd week after the accident. Selected patients were evaluated with psychological and psychosocial tests and questionnaires 6 months after head injury, among them: WAIS, Benton Test, Rey Osterrieth Test, Wisconsin Cards, Psychosocial Scale and Neurobehavioural Rating Scale (NRS-27). RESULTS: No significant differences were observed in relation to demographic characteristics, type of head injury, GCS, or psychometric results. Significant differences were found in the answers to neurobehavioural and psychosocial questionnaires, showing more impairment in patients with OPD. CONCLUSIONS: The results show that, in this group, patients with OPD after TBI present more psychosocial adjustment and emotional problems than patients with TBI without OPD diagnosis. The difference found is independent of cognitive impairments.

Emotional and psychosocial factors in burn patients during hospitalization.

This is a preliminary study of psychological symptoms, prior psychosocial adjustment and severity of injury in 25 consecutive burn patients. All had suffered burns in work-related accidents and were evaluated by the psychiatric consulation-liaison team during their initial hospitalization in the Burn Unit of the Hospital del Trabajador, Santiago. All patients were clinically evaluated and the following instruments were applied: Hamilton Scales of Anxiety (HAM-A) and Depression (HAM-D), Goldberg's General Health Questionnaire (GHQ-28), Cloninger's Tridimensional Personality Questionnaire (TPQ) and a modified version of a Schooler's Adjustment Scale. No significant correlation was found between extent and severity of burns and anxious or depressive symptoms. However, all patients had burns that varied from mild to moderate; there were no severe and extensive injuries. A significant correlation was found between anxiety and the harm avoidance dimension in the TPQ, as would be expected. Patients with poor psychosocial adjustment presented with greater anxiety symptoms. A significant negative correlation was also found between degree of anxiety symptoms and income level. The main findings are in agreement with current literature. They emphasize the relevance of prior psychosocial adjustment and personality as probable factors of psychological symptoms. The need to control pain as a variable is also pointed out.