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Traumatic brain injury in adults includes blunt trauma and traumatic brain injury. Traumatic brain injury can have serious consequences, including varying degrees of mental disturbance.
1. What is a traumatic brain injury?
Traumatic brain injury is a change in the function of the brain due to external forces (such as collisions during traffic accidents, labor, daily activities).
When the brain is affected by an external agent, it can affect a corresponding area of the brain, which can be the area directly affected, or the area indirectly affected by the collision with the brain. skull, or damage to the blood vessels that feed it...
The most common traumatic brain injuries are focal infarction, contusion, ventricular dilatation, extensive cerebral edema, ... Structural injuries The neural architecture of each region will cause very complex functional changes.
2. Mental disorders can be seen in people with traumatic brain injury
Cognitive impairment: Patients are often unable to process as much information and quickly as they did before the injury. In addition, people also have reduced abilities related to executive functions such as planning, organizing work, thinking, adapting to the environment, assessing, identifying problems, controlling impulse. Impaired concentration and memory: Patients with traumatic brain injury often find it difficult to maintain concentration for a long time to complete tasks, and at the same time, it is also difficult to receive and remember new knowledge. When people are able to maintain immediate memory, they often have problems with near and far memory. Visual impairment: Severe traumatic brain injury can cause the patient to lose the ability to receive and reproduce images. Language impairment: Patients often have difficulty finding words or naming objects (signs of aphasia, aphasia). However, language disorders have a higher rate of recovery than impairments in memory and other cognitive functions. Dementia : Only seen in patients with severe traumatic brain injury, however, the number is relatively small. Mental recovery time is about 3 years. Psychosis: The proportion of patients with psychosis secondary to traumatic brain injury accounts for about 4-9% of the total cases, the time of symptoms appearing from a few days or even up to 20 years after the injury. However, most psychotic symptoms manifest within the first 5 years, and patients with early psychotic symptoms also often have diffuse brain damage with prominent symptoms and delusions. Meanwhile, patients with longer disease progression have focal lesions in the frontal lobe, accompanied by a history of seizures associated with traumatic brain injury. Common psychotic symptoms are delusions of damage, auditory hallucinations, visual hallucinations, negative symptoms, stereotypical thinking disorder. These symptoms tend to develop chronically and can develop into true schizophrenia.
Bệnh nhân được chẩn đoán mắc chứng trầm cảm khoảng một năm đầu sau chấn thương
Depression: The patient was diagnosed with depression approximately one year after the injury. Depression reduces executive functioning, increases anxiety, and increases the risk of suicide. Depressive presentation is common in patients with traumatic brain injury with lesions in the dorsolateral prefrontal cortex and basal ganglia. If a patient presents with exaggerated trauma and poorly coordinated recovery, it could be an early warning sign of depression. In the early period after trauma, depression can be seen as a feeling of loss, loss of motivation, and depersonalization. Later, the patient may often fall into a state of depression, accompanied by fatigue, irritability, loss of interest, and prolonged insomnia. Mania: Common in patients with traumatic brain injury with lesions located in the limbic system or the right hemisphere connected to the limbic system, atrophy of the anterior subcortical region. The clinical manifestation of mania is irritability. Suicide: A type of emotional disturbance associated with increased levels of suicidal thoughts, suicide attempts, or death by suicide. Suicides after traumatic brain injury report personality changes, alcoholism, difficulties in relationships or personal interactions. Suicide is often associated with damage to the frontal or temporal lobes. Anxiety disorders: Common at the site of damage to the right hemisphere of the brain. Post-Traumatic Stress Disorder: Patients with this disorder will retain horrific images of the event that caused the accident, more common in women than in men and also higher than in the group with acute stress disorder. Obsessive-compulsive disorder: Associated with impairment of cortical function in the frontal-orbital cortex, which is a conduction pathway in the subfrontal cortex and executive function. Post-concussion syndrome: The syndrome appears in patients with traumatic brain injury with manifestations such as headache, dizziness, lightheadedness, pain in other parts of the body, fatigue, muscle weakness, confusion. sleep, impaired concentration and memory, or possibly memory loss, decreased vision, sensitivity to light/noise, ringing in the ears, or depression, irritability, confusion, behavior changes emotions, lack of confidence, decreased reactivity, judgment, depression and anxiety. In young children, the acute symptoms of a concussion are restlessness, lethargy, lethargy, irritability, and irritability. The syndrome usually begins within the first month after a traumatic brain injury and recovers after about 3 to 6 months, however, full recovery takes up to 1 year. Aggression: Is one of the personality changes in patients after trauma, affecting their ability to recover and making it difficult for loved ones to take care of them; may present alone or in the setting of another mental disorder, or as an existing personality change. Aggression following traumatic brain injury is often associated with new onset of major depression, impaired social functioning, and increased dependence in daily living. Apathy, emotional instability: With manifestations such as overexpression of emotions, and usually not associated with depression. Impaired sexual function: Transient hypogonadism occurs in the majority of patients after traumatic brain injury. Along with that, muscle weakness and osteoporosis due to long-term immobility have negatively affected the patient's fertility and psychosocial function. Sleep disorders: Common disorders include insomnia or excessive sleep, sleep-wake rhythm disturbances, decreased sleep quality or restless sleep, decreased melatonin production in the evening. Sleep disturbances aggravate other symptoms such as fatigue, irritability, pain, and cognitive impairment, thus often affecting the rehabilitation process and the patient's ability to return to work.
Các dạng rối loạn thường gặp gồm mất ngủ hoặc ngủ nhiều, rối loạn nhịp thức - ngủ, giảm chất lượng giấc ngủ hoặc ngủ chập chờn
3. Treatment of mental disorders in people with traumatic brain injury
Treatment of mental disorders in patients with traumatic brain injury is mainly about treating symptoms and restoring mental functions.
Treatment of neurasthenia symptoms: tranquilizers and antidepressants can be used. Treatment of traumatic seizures: use of antiepileptic drugs. Rehabilitation of functions: physical therapy, sports practice, ... To prevent traumatic brain injury that can cause mental disorders, accidents should be limited by observing safety rules. traffic, labor safety; wear helmets, protection when participating in traffic and work.
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