The cognitive and behavioural problems of schizophrenia overlap considerably with those produced by traumatic brain injury. Antisocial behaviours, apathy and lack of spontaneity, and erratic mood swings are common to both. Both will show cognitive problems including disorders of communication, memory, and planning. Will a head injury therefore aggravate these more negative symptoms of schizophrenia? Given that a significant proportion of head trauma is found in people with schizophrenia who have jumped from a height, the question arises from time to time. As yet there are no studies of the outcome.
Mood disorders, including anxiety disorders Depression
The study of depression after head injury raises two fundamental questions about the nosological status of depression. First, with a severe disability should the belief that life is not worth living be regarded as a symptom of depression or a 'rational' reaction to an intolerable predicament? Second, what is one to make of symptoms of apathy or anhedonia when the brain pathways involved in generating spontaneous behaviour or the experience of pleasure have been damaged? Most of the biological symptoms of depression can be produced by brain injury.
The diagnosis of depression therefore relies heavily on identifying a depressive mood. Symptoms like self-deprecation or guilt are also particularly helpful in diagnosis. Estimates of the prevalence of depression after head injury vary, partly because of the lack of uniformity in defining depression. Perhaps 25 per cent of patients meet DSM-IIIR criteria for major depression 1 month after injury/46) The majority have recovered from their depression by 6 months, while at 1 year 10 to 20 per cent of those previously not depressed have become depressed.
Aetiological factors include a personal history of depression, which is twice as common in those who become depressed, and lack of social support. Left frontal injury predicts the development of depression within 3 months of a closed head injury, but does not predict those who are depressed at 1 year. Two large follow-up studies have found that after penetrating injuries depression at 1 year is associated with right hemisphere damage, particularly of the frontal lobes.
Depression after head injury interferes with rehabilitation, and is associated with aggression. It may exacerbate cognitive impairment and in some cases produce a pseudodementia.
Emotional lability may occur, particularly after severe head injury, and is frequently associated with the presence of depression.
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