Traumatic Brain Injury

This is the commonest cause of neuropsychiatric disability, and a major part of the workload of those psychiatrists practicing neuropsychiatry in this country. The prevalence has been estimated at 437 per 100,000 hospital presentations for mild TBI per year and possibly 700 per 100,000 first medical consultations for TBI per year in New Zealand. The assessment and rehabilitation of affected individuals is largely the responsibility of the Accident Compensation and Rehabilitation Corporation. The major NGOs assisting individuals and their families are the Brain Injury Association and the Head Injury Association. The Waikato is covered by Head Injury Society Waikato. Private providers with residential facilities include Ranworth Healthcare and Cavit ABI.

The New Zealand TBI management guidelines were updated by the New Zealand Guidelines Group in a evidence based best-practice guideline published in July 2006 and this is a useful overview of knowledge and recommendations. Specific advice on medication were avoided as the literature is quite patchy and so recommendations would need to be based on adequate clinical experience.

Some information about Mild Traumatic Brain Injury. Here is a brief tutorial (in power point) on neuropsychiatric aspects of TBI.

There is a recent useful set of review articles in the Journal of Head Trauma Rehabilitation (link below) especially those from the Jan/Feb 2005 copy (Vol 20 no 1) including Ronald Ruff on mild TBI, George Prigitano on disorders of awareness, Mel Glenn and Bruno Wroblewski on pharmacology, Catherine Mateer and others on cognitive and emotional rehabilitation, John Povlishock and Douglas Katz on neuropathology, and Mark Ylvisaker and others on pediatric rehab and support.

The UK group of psychiatrists with an interest in TBI have modified the Health of the Nation Outcome Scales, becoming a widely used tool in mental health services and service planning, for traumatic brain injury and a copy is available here as a discussion point.

Suggested reading

For those affected and their families:

  • Trevor Powell - Head Injury: a practical guide. Speechmark, 2004.
  • Gronwall D, Wrightson P, and Waddell P- Head Injury: the facts. Second edition. Oxford, 1998
  • Diane Roberts Stoller - Coping with Mild Traumatic Brain Injury. Avery, 1998.

For professionals:

  • Horn LJ and Zasler N (eds): Medical Rehabilitation of Traumatic Brain Injury. Hanley & Belfus, 1996.
  • Raskin SA and Mateer CA - Neuropsychological management of Mild Traumatic Brain Injury. Oxford, 2000.
  • Rizzo M and Tranel D (eds) - Head Injury and Postconcussive Syndrome. Churchill Livingstone, 1996.
  • Silver JM, Yudofsky SC and Hales RE - The Neuropsychiatry of Traumatic Brain Injury. APP, 1994.
  • Wood RLl and McMillan TM - Neurobehavioural Disability and Social Handicap following Traumatic Brain Injury. Psychology Press, 2001.
  • Wrightson P and Gronwall D Mild Head Injury; a guide to management. Oxford, 1999.

Historical aspects:

  • Trimble MR - Post-traumatic neurosis: from railway spine to the whiplash. Wiley, 1981.
  • Wrightson P: (to be added)

Additional Journals:


A bibliography of papers by Philip Wrightson