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Traumatic Brain Injury

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by

Michelle Souza

on 10 February 2014

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Transcript of Traumatic Brain Injury

Traumatic Brain Injury / Medical Condition
By: Michelle Souza
DSM - V
Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury (TBI)
Neurocognitive Disorders (NCD)
907.0 (S06.2X9S) diffuse traumatic brain injury with loss of consciousness of unspecified duration, sequela

294.11 (F02.81) Major, with behavioral disturbance
294.10 (F02.80) Major, without behavioral disturbance
331.83 (G31.84) Mild NCD due to TBI
Description
Brain has been damaged
Change in cognitive functioning
Physical and mental limitations
Cognitive presentation is variable.
Difficulties in the domains of:
Complex attention
Executive ability
Learning
Memory
Slowing in speed of information processing
Disturbances in social cognition
Personality changes
Neurocognitive Disorders (NCDs)
Clinical deficit in
cognitive function
Disorder is acquired, not developed
A decline in level of functioning
Causes may be determined
Delirium, Major / Mild + subtypes
Diagnostic Criteria
B. There is evidence of a traumatic brain injury—that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following:

1. Loss of consciousness.
2. Post-traumatic amnesia.
3. Disorientation and confusion.
4. Neurological signs evidence is required for Major NCD

C. The neurocognitive disorder presents immediately after the occurrence of the traumatic brain injury or immediately after recovery of consciousness and persists past the acute post-injury period.
Major NCD
Significant Cognitive Decline
Interfere with independence
Not due to delirium
Not due to other mental disorder
Mild NCD
A. The criteria are met for
major
or
mild
neurocognitive disorder.
Specific Features
Culture
Recovery
Sports ie. football, baseball, boxing, racing
Military Troops
Domestic Violence
Physical Abuse
Subtance Abuse
delays in reaching developmental milestones
worse academic performance,
impaired social development.
Gender
59% Males
Males 0-4 > ER visits
Prevalence
Treatment of choice
or Alternatives
THANK YOU
ICD-9 | ICD-10
Subtypes
• Alzheimer’s disease
• Vascular disease
• Lewy bodies disease
• Parkinson’s disease
• Frontotemporal lobar degeneration
• HIV infection
• Substance/medication-induced
• Huntington’s disease
• Prion disease
• Another medical condition
• Multiple etiologies
• Unspecified
DSM - V

Taumatic brain injury
10 Million worldwide/year
1.7 Million US/year
1.4 Million ER visits
275,000 hospitalizations
52,000 deaths
1/3 (30.5%) of all injury-related deaths
2% disabled
Falls, car accidents, struck on head
Development and Course
incomplete recoveries.
Older individuals
various neurocognitive deficits
irritability
hypersensitivity to light and sound
easy fatigability
mood changes (including depression, anxiety, hostility, or apathy)
Infant or child
Older teenagers and adults
Age
What else it looks like
Dementia
NCD Subtypes
Depression
Anxiety
Posttraumatic Stress Disorder
OCD
Schizophrenia
ADHD
Learning Disorders
How to differentiate
Default diagnosis
Alzheimer's
Malingering
Somatic Symptom Disorder
Factitious Disorder
PTSD

Differential Diagnosis
Severity is rated at the time of injury
Recovery is dependent of cofactors
Mild TBI is resolved within 3 months
Moderate and Severe TBI may percist
Neurophysiological, emotional, behavioral Complications
Risk
Depression
Aggression
Neurodegenerative diseases (Alzheimer's)
Gather clinical history
Access premorbid functioning
Neurophsychological Testing
Anxiety reduction during assessment
Age of onset
Contingent upon TBI severity
Neurosurgery
Rehabilitation
Family education and therapy
Cognitive Rehabilitation
Psychotherapy
Systems of Care
Children 0 - 4
Adolescents 15 - 19
Adults 65 +
Moderate Cognitive Decline
NOT Interfere with independence
Not due to delirium
Not due to other mental disorder
Full transcript