Neuropsychological and psychiatric comorbidities of mild traumatic brain injury

The assessment and treatment of neuropsychological and psychiatric symptoms in patients with histories of traumatic brain injury (TBI) presents several challenges, including: (1) proper classification at the mild end of the injury spectrum, which comprises at least 80% of all patients; (2) the nature of postconcussive symptoms, their longitudinal course, and relationship to structural brain injury versus other consequences of brain injury events; (3) lack of comprehensive, evidence-based interventions for early and late post-TBI symptoms; and (4) uncertainty about possible relationships between TBI and later neurodegenerative disorders. This chapter will review each of these problems in turn with emphasis on mild TBI, where these controversies are most unsettled. A practical approach is suggested that emphasizes identification of structural, functional, and psychological conditions and consideration of each patient’s social context without falling into unresolvable diagnostic dilemmas, followed by interventions that emphasize recovery, supplemented by cognitive rehabilitation and cognitive behavioral therapy.