BPSD following traumatic brain injury

Anghinah, Renato; Freire, Fabio Rios; Coelho, Fernanda; Lacerda, Juliana Rhein; Schmidt, Magali Taino; Calado, Vanessa Tomé Gonçalves; Ianof, Jéssica Natuline; Machado, Sergio; Velasques, Bruna; Ribeiro, Pedro; Basile, Luis Fernando Hindi; Paiva, Wellingson Silva; Amorim, Robson Luis

doi:10.1590/S1980-57642013DN70300007

ABSTRACT

Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. Objective: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period.

Methods:

Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted.

Results:

Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI.

Conclusion: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

Key words:
TBI; traumatic brain injury; BPSD; treatment.

RESUMO

Anualmente, 700 mil pessoas são hospitalizadas com lesão encefálica adquirida após traumatismo cranioencefálico (TCE) no Brasil.

Objetivo:

Nossa meta é revisar os conceitos básicos relacionados ao TCE, e aos Sintomas Comportamentais e Psicológicos da Demência (BPSD) encontrados nos sobreviventes de TCE moderado e grave. Também discutimos as estratégias utilizadas para lidar com os pacientes pós-TCE.

Métodos:

Quinze pacientes ambulatoriais acompanhados no Centro de Reabilitação Cognitiva pós-traumatismo cranioencefálico do Hospital das Clínicas de São Paulo foram submetidos a avaliações neurológica, neuropsicológica, fonoaudiológica e de terapia ocupacional, incluindo o mini exame do estado mental. Em seguida, estratégias de reabilitação serão desenvolvidas, com a equipe multidisciplinar, para cada paciente individualmente. E, se necessário, a abordagem farmacológica será adotada.

Resultados:

Nosso estudo irá discutir as opções de escolha de tratamento farmacológico para desordens cognitivas, comportamentais e afetivas pós-TCE, fornecendo informações relevantes relacionadas a um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE.

Conclusão:

O traumatismo cranioencefálico pode causar uma variedade de sintomas e síndromes psiquiátricos potencialmente incapacitantes. As estratégias farmacológica e comportamental combinadas para o tratamento de um conjunto de problemas comportamentais muito desafiador parece ser essencial para uma boa recuperação do paciente.

Palavras-chave:
TCE; traumatismo cranioencefálico; BPSD; tratamento.

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Full text available only in PDF format.

REFERENCES

Schewinsky SR. In Reabilitação neuropsicológica da memória no TCE. 1ª ed., São Paulo, SP: Livraria Médica Paulista; 2008.
Harmon RL, Lawrence JH. Traumamatic Brain Injury. In: Bryan J, Mark A, Steven A (Editors). Phisical medicine and rehabilitation secrets, 2ª ed., Philadelphia: Mosby; 2001.a 2008: xvii.
Jang SH. Review of motor recovery in patients with traumatic brain injury. NeuroRehabilitation 2009;24:349-353.
Jennett B, Snoak J, Bond M, Brooks N. Disability after severe head injury: observations on use of Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 1981;44:285-293.
Silva SCF, Sousa RMC. Galveston Orientation and Amnesia Test: tradução e validação. Acta Paul Enferm 2007:24-29.
Mansur LL, Radanovic M, (Editores). Neurolinguistica: Princípios para a prática clínica. São Paulo: Edições Inteligentes; 2004.
Hagen C. Language cognitive disorganization following closed head injury: a conceptualization. In: Trexler L, editor. Cognitive rehabilitation: conceptualization and intervention. New York: Plenum Press; 1982:131-151.
Tuel SM, Presty SK, Meythaler JM, Heinemann AW, Katz RT. Functional improvement in severe head injury after readmission for rehabilitation. Brain Inj 1992;6:363-372.
Katz RT, DeLuca J. Sequelae of minor traumatic brain injury. Am Fam Physician 1992;46:1491-1498.
Zafonte RD, Hammond FM, Mann NR, Wood DL, Black KL, Millis SR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil 1996;75:364-369.
Vallat-Azouvi C, Weber T, Legrand L, Azouvi P. Working memory after severe traumatic brain injury. J Int Neuropsychol Soc 2007;13:770-780.
Nicholl J, LaFrance WC Jr. Neuropsychiatric sequelae of traumatic brain injury. Semin Neurol 2009;29:247-55.
Whyte J, Vaccaro M, Grieb-Neff P, Hart T. Psychostimulant use in the rehabilitation of individuals with traumatic brain injury. J Head Trauma Rehab. 2002;17:284-299.
Phillips JP, Devier DJ, Feeney DM. Rehabilitation pharmacology: bridging laboratory work to clinical application. J Head Trauma Rehabil 2003;18:342-356.
Forsyth R, Baxter P, Elliott T. Routine intracranial pressure monitoring in acute coma. Cochrane Database Syst Rev 2001(3):CD002043.
Zafonte RD, Lexell J, Cullen N. Possible applications for dopaminergic agents following traumatic brain injury: part 1. J Head Trauma Rehab 2000;15:1179-1182.
McDowell S, Whyte J, D'Esposito. Differential effect of a dopaminergic agonist on prefrontal function in traumatic brain injury patients. Brain 1998;121:1155-1164.
Schneider WN, Drew-Cates J, Wong TM, Dombovy ML. Cognitive and behavioral efficacy of amantadine in acute traumatic brain injury: an initial double-blind placebo-controlled study. Brain Inj1999;13:863-872.
Passler MA, Riggs RV. Positive outcomes in traumatic brain injury-vegetative state: patients treated with bromocriptine. Arch Physical Med Rehabil 2001;82: 311-315.
Jacobs BL, Fornal CA. 5-HT and motor control: a hypothesis. Trends Neurosci 1993;16:346-352.
Loubinoux I, Pariente J, Boulanouar K, et al. A single dose of the serotonin neurotransmission agonist paroxetine enhances motor output: double-blind, placebo-controlled, fMRI study in healthy subjects. NeuroImage 2002;15:26-36.
Hindmarch I. The behavioural toxicity of the selective serotonin reuptake inhibitors. Int Clin Psychopharmacol 1995;9:13-17.
Hasbroucq T, Rihet P, Blin O, Possamai C-A. Serotonin and human information processing: fluvoxamine can improve reaction time performance. Neurosci Lett 1997;229:204-208.
Öhman J, Braakman R, Legout V. Repinotan (BAY x 3702): a 5HT1a agonist in traumatically brain injured patients. J Neurotrauma 2001; 18:1313-1321.
Blount PJ, Nguyen CD, McDeavitt JT. Clinical use of cholinomimetic agents: a review. J Head Trauma Rehab il2002;17:314-321.
Tower D, McEachern D. Acetylcholine and neuronal activity in craniocerebral trauma, J Clin Invest 1948;27:558-559.
McIntosh TK, Juhler M, Wieloch T. Novel pharmacologic strategies in the treatment of experimental traumatic brain injury. J Neurotrauma1998;15:731-769.
Hepler DJ, Olton DS, Wenk GL, et al. Lesions in nucleus basilis magnocellularis and medial septal area of rats produce qualitatively similar memory impairments. J Neurosci 1985;5:866-873.
Miyamoto M, Kato J, Narumi S, et al. Characteristics of memory impairment following lesioning of the basal forebrain and medial septal nucleus in rats. BrainRes 1987;419:19-30
Cardenas DD, McLean A Jr, Farrell-Roberts L, Baker L, Brooke M, Haselkorn J. Oral physostigmine and impaired memory in adults with brain injury. Brain Inj1994;8:579-587.
Taverni JP, Seliger G, Lichtman SW. Donepezil medicated memory improvement in traumatic brain injury during post acute rehabilitation. Brain Inj1998;12:77-80.
Masanic CA, Bayley MT, VanReekum R, Simard M. Open-label study of donepezil in traumatic brain injury. Arch Phys Med Rehabil 2001;82: 896-901.
Zafonte RD, Hammond FM, Mann NR, Wood DL, Black KL, Millis SR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil1996;75:364-369.
Folstein MH, Folstein SM, McHugh PR. "Mini-Mental State". A practical method for grading the cognitive state of patients for clinicians. J Psychiat Res 1975; 12:189-198.
Bertolucci PHF, Mathias SC, Brucki SMD, Carrilho PEM, Okamoto IH, Nitrini R. Proposta de padronização do Mini-Exame do Estado Mental (MEEM): estudo piloto cooperativo (FMUSP/EPM). Arq Neuropsiquiatr 1994;52:225.
Cunha JA. Manual da versão em português das escalas de BECK. São Paulo: Casa do Psicólogo; 2001.
Lipp MEN. Inventário de Sintomas de stress para adultos de LIPP (ISSL).; São Paulo: Casa do Psicólogo 2000.
Yesavage JA. Development and validation of a geriatric depression screening scale:a preliminary report. J Psychiatr Res 1982-83;17:37-49.
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
Wisconsin Card Sorting Test. Psychological Assessment Resources, Inc- Odessa; 1993.
Sawchyn JM, Brulot MM, Strauss E. Note on the use of the Postconcussion Syndrome Checklist. Arch Clin Neuropsychol 2000;15:1-8.
Otfried Spreen, Esther Strauss. Compendium of Neuropsychological Tests: administration, Norms, and Commentary, 2ª Ed. New York: Oxford University Press;1998.
Rey A. L'examen psychologique dans les cas d'encephalopathie traumatique. Arch Psychol 1941; 28:286-340.
Wechsler D. Wechsler Adult Intelligence Scale. 3. New York: Psychological Corporation;1997.
Trail Making Test. In: Spreen O, Strauss E, (Editors). A Compendium of Neuropsychological Tests: administration, Norms, and Commentary, 2ª Ed. New York: Oxford UniversityPress; 1998:533-546.
Brucki SMD, Rocha MSG. Category fluency test: effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004; 37:1771- 1777.
Rey-Osterrieth complex figure test (SFT). In: Spreen O, Strauss E, A Compendium of Neuropsychological Tests: administration, Norms, and Commentary, 2ª Ed. New York: Oxford UniversityPress; 1998:341-363.
Bayles KA, Tomoeda CK. Arizona Battery for Communication Disorders of Dementia. Tucson: Canyonlands Publishing; 1994.
Erez ABH, Rothschild E, Katz N, Tuchner M, Hartman-Maeir A. Executive Functioning, Awareness, and Participation in Daily Life After Mild Traumatic Brain Injury: A Preliminary Study. Am J Occup Ther 2009; 63:634-640.
Powell JM, Temkin NR, Machamer JE, Dikmen SS. Gaining Insight Into Patients' Perspectives on Participation in Home Management Activities After Traumatic Brain Injury. Am J Occup Ther2007; 61:269-279.
Hartman-Maeir A, Katz N, Baum CM. Cognitive Functional Evaluation (CFE) Process for Individuals with Suspected Cognitive Disabilities. Occup Ther Health Care 2009;23:1-23.
Katz N, Itzkovich M, Averbuch S, Elazar B. Loewenstein Occupational. Therapy Cognitive Assessment (LOTCA) battery for brain-injured patients: reliability and validity. Am J Occup Ther 1989;43:184-192.
Brayman SJ, Clark GF, DeLany JV, et al. Commission on Practice. Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. Am J Occup Ther 2009;63: 797-803.
Mega MS, Cummings JL. Frontal-subcortical circuits and neuropsychiatric disorders. J Neuropsychiatry Clin Neurosci 1994;6:358-370.
Marin R, Chakravorty S. Disorders of diminished motivation. In: Silver JM, McAllister TW, Yudofsky SC, eds. Textbook of Traumatic Brain Injury. 1st ed. Washington, DC: American Psychiatric Pub; 2005:343.
Wroblewski BA, Joseph AB, Cornblatt RR. Antidepressant pharmacotherapy and the treatment of depression in patients with severe traumatic brain injury: a controlled, prospective study. J Clin Psychiatry 1996;57:582-587.
Lee H, Kim SW, Kim JM, Shin IS, Yang SJ, Yoon JS. Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injury. Hum Psychopharmacol 2005;20:97-104.
Sawyer E, Mauro LS, Ohlinger MJ. Amantadine enhancement of arousal and cognition after traumatic brain injury. Ann Pharmacother 2008; 42:247-252.
Tenovuo O. Central acetylcholinesterase inhibitors in the treatment of chronic traumatic brain injury-clinical experience in 111 patients. Prog Neuropsychopharmacol Biol Psychiatry 2005;29:61-67.
Pope HG Jr, McElroy SL, Satlin A, Hudson JI, Keck PE Jr, Kalish R. Head injury, bipolar disorder, and response to valproate. Compr Psychiatry 1988; 29:34-38.
Fujii D, Ahmed I. Psychotic disorder following traumatic brain injury: a conceptual framework. Cogn Neuropsychiatry 2002;7:41-62.
Sachdev P, Smith JS, Cathcart S. Schizophrenia-like psychosis following traumatic brain injury: a chart-based descriptive and case-control study. Psychol Med 2001;31:231-239.
McAllister TW, Ferrell RB. Evaluation and treatment of psychosis after traumatic brain injury. NeuroRehabilitation2002;17:357-368.
Hoffman AN, Cheng JP, Zafonte RD, Kline AE. Administration of haloperidol and risperidone after neurobehavioral testing hinders the recovery of traumatic brain injury-induced deficits. Life Sci 2008;83:602-607.
Carroll LJ, Cassidy JD, Peloso PM, et al; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004;(43, Suppl):84-105.
Silver JM, Koumaras B, Chen M, et al. Effects of rivastigmine on cognitive function in patients with traumatic brain injury. Neurology 2006; 67:748-755.
Gualtieri CT, Evans RW. Stimulant treatment for the neurobehavioural sequelae of traumatic brain injury. Brain Inj1988;2:273-290.
Silver JM, Yudofsky SC, Anderson KE. Aggressive disorders. In: Silver JM, McAllister TW, Yudofsky SC, eds. Textbook of Traumatic Brain Injury. 1st ed. Washington, DC: American Psychiatric Pub lishing Inc; 2005:261.
Grafman J, Schwab K, Warden D, Pridgen A, Brown HR, Salazar AM. Frontal lobe injuries, violence, and aggression: a report of the Vietnam Head Injury Study. Neurology1996;46: 12 31-1238.
Warden DL, Gordon B, McAllister TW, et al; Neurobehavioral Guidelines Working Group. Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury. J Neurotrauma2006; 23:1468-1501.

Publication Dates

Publication in this collection
Jul-Sep 2013

History

Received
07 May 2013
Accepted
02 Aug 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Schewinsky SR. In Reabilitação neuropsicológica da memória no TCE. 1ª ed., São Paulo, SP: Livraria Médica Paulista; 2008.

[2] Harmon RL, Lawrence JH. Traumamatic Brain Injury. In: Bryan J, Mark A, Steven A (Editors). Phisical medicine and rehabilitation secrets, 2ª ed., Philadelphia: Mosby; 2001.a 2008: xvii.

[3] Jang SH. Review of motor recovery in patients with traumatic brain injury. NeuroRehabilitation 2009;24:349-353.

[4] Jennett B, Snoak J, Bond M, Brooks N. Disability after severe head injury: observations on use of Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 1981;44:285-293.

[5] Silva SCF, Sousa RMC. Galveston Orientation and Amnesia Test: tradução e validação. Acta Paul Enferm 2007:24-29.

[6] Mansur LL, Radanovic M, (Editores). Neurolinguistica: Princípios para a prática clínica. São Paulo: Edições Inteligentes; 2004.

[7] Hagen C. Language cognitive disorganization following closed head injury: a conceptualization. In: Trexler L, editor. Cognitive rehabilitation: conceptualization and intervention. New York: Plenum Press; 1982:131-151.

[8] Tuel SM, Presty SK, Meythaler JM, Heinemann AW, Katz RT. Functional improvement in severe head injury after readmission for rehabilitation. Brain Inj 1992;6:363-372.

[9] Katz RT, DeLuca J. Sequelae of minor traumatic brain injury. Am Fam Physician 1992;46:1491-1498.

[10] Zafonte RD, Hammond FM, Mann NR, Wood DL, Black KL, Millis SR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil 1996;75:364-369.

[11] Vallat-Azouvi C, Weber T, Legrand L, Azouvi P. Working memory after severe traumatic brain injury. J Int Neuropsychol Soc 2007;13:770-780.

[12] Nicholl J, LaFrance WC Jr. Neuropsychiatric sequelae of traumatic brain injury. Semin Neurol 2009;29:247-55.

[13] Whyte J, Vaccaro M, Grieb-Neff P, Hart T. Psychostimulant use in the rehabilitation of individuals with traumatic brain injury. J Head Trauma Rehab. 2002;17:284-299.

[14] Phillips JP, Devier DJ, Feeney DM. Rehabilitation pharmacology: bridging laboratory work to clinical application. J Head Trauma Rehabil 2003;18:342-356.

[15] Forsyth R, Baxter P, Elliott T. Routine intracranial pressure monitoring in acute coma. Cochrane Database Syst Rev 2001(3):CD002043.

[16] Zafonte RD, Lexell J, Cullen N. Possible applications for dopaminergic agents following traumatic brain injury: part 1. J Head Trauma Rehab 2000;15:1179-1182.

[17] McDowell S, Whyte J, D'Esposito. Differential effect of a dopaminergic agonist on prefrontal function in traumatic brain injury patients. Brain 1998;121:1155-1164.

[18] Schneider WN, Drew-Cates J, Wong TM, Dombovy ML. Cognitive and behavioral efficacy of amantadine in acute traumatic brain injury: an initial double-blind placebo-controlled study. Brain Inj1999;13:863-872.

[19] Passler MA, Riggs RV. Positive outcomes in traumatic brain injury-vegetative state: patients treated with bromocriptine. Arch Physical Med Rehabil 2001;82: 311-315.

[20] Jacobs BL, Fornal CA. 5-HT and motor control: a hypothesis. Trends Neurosci 1993;16:346-352.

[21] Loubinoux I, Pariente J, Boulanouar K, et al. A single dose of the serotonin neurotransmission agonist paroxetine enhances motor output: double-blind, placebo-controlled, fMRI study in healthy subjects. NeuroImage 2002;15:26-36.

[22] Hindmarch I. The behavioural toxicity of the selective serotonin reuptake inhibitors. Int Clin Psychopharmacol 1995;9:13-17.

[23] Hasbroucq T, Rihet P, Blin O, Possamai C-A. Serotonin and human information processing: fluvoxamine can improve reaction time performance. Neurosci Lett 1997;229:204-208.

[24] Öhman J, Braakman R, Legout V. Repinotan (BAY x 3702): a 5HT1a agonist in traumatically brain injured patients. J Neurotrauma 2001; 18:1313-1321.

[25] Blount PJ, Nguyen CD, McDeavitt JT. Clinical use of cholinomimetic agents: a review. J Head Trauma Rehab il2002;17:314-321.

[26] Tower D, McEachern D. Acetylcholine and neuronal activity in craniocerebral trauma, J Clin Invest 1948;27:558-559.

[27] McIntosh TK, Juhler M, Wieloch T. Novel pharmacologic strategies in the treatment of experimental traumatic brain injury. J Neurotrauma1998;15:731-769.

[28] Hepler DJ, Olton DS, Wenk GL, et al. Lesions in nucleus basilis magnocellularis and medial septal area of rats produce qualitatively similar memory impairments. J Neurosci 1985;5:866-873.

[29] Miyamoto M, Kato J, Narumi S, et al. Characteristics of memory impairment following lesioning of the basal forebrain and medial septal nucleus in rats. BrainRes 1987;419:19-30

[30] Cardenas DD, McLean A Jr, Farrell-Roberts L, Baker L, Brooke M, Haselkorn J. Oral physostigmine and impaired memory in adults with brain injury. Brain Inj1994;8:579-587.

[31] Taverni JP, Seliger G, Lichtman SW. Donepezil medicated memory improvement in traumatic brain injury during post acute rehabilitation. Brain Inj1998;12:77-80.

[32] Masanic CA, Bayley MT, VanReekum R, Simard M. Open-label study of donepezil in traumatic brain injury. Arch Phys Med Rehabil 2001;82: 896-901.

[33] Zafonte RD, Hammond FM, Mann NR, Wood DL, Black KL, Millis SR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil1996;75:364-369.

[34] Folstein MH, Folstein SM, McHugh PR. "Mini-Mental State". A practical method for grading the cognitive state of patients for clinicians. J Psychiat Res 1975; 12:189-198.

[35] Bertolucci PHF, Mathias SC, Brucki SMD, Carrilho PEM, Okamoto IH, Nitrini R. Proposta de padronização do Mini-Exame do Estado Mental (MEEM): estudo piloto cooperativo (FMUSP/EPM). Arq Neuropsiquiatr 1994;52:225.

[36] Cunha JA. Manual da versão em português das escalas de BECK. São Paulo: Casa do Psicólogo; 2001.

[37] Lipp MEN. Inventário de Sintomas de stress para adultos de LIPP (ISSL).; São Paulo: Casa do Psicólogo 2000.

[38] Yesavage JA. Development and validation of a geriatric depression screening scale:a preliminary report. J Psychiatr Res 1982-83;17:37-49.

[39] Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[40] Wisconsin Card Sorting Test. Psychological Assessment Resources, Inc- Odessa; 1993.

[41] Sawchyn JM, Brulot MM, Strauss E. Note on the use of the Postconcussion Syndrome Checklist. Arch Clin Neuropsychol 2000;15:1-8.

[42] Otfried Spreen, Esther Strauss. Compendium of Neuropsychological Tests: administration, Norms, and Commentary, 2ª Ed. New York: Oxford University Press;1998.

[43] Rey A. L'examen psychologique dans les cas d'encephalopathie traumatique. Arch Psychol 1941; 28:286-340.

[44] Wechsler D. Wechsler Adult Intelligence Scale. 3. New York: Psychological Corporation;1997.

[45] Trail Making Test. In: Spreen O, Strauss E, (Editors). A Compendium of Neuropsychological Tests: administration, Norms, and Commentary, 2ª Ed. New York: Oxford UniversityPress; 1998:533-546.

[46] Brucki SMD, Rocha MSG. Category fluency test: effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004; 37:1771- 1777.

[47] Rey-Osterrieth complex figure test (SFT). In: Spreen O, Strauss E, A Compendium of Neuropsychological Tests: administration, Norms, and Commentary, 2ª Ed. New York: Oxford UniversityPress; 1998:341-363.

[48] Bayles KA, Tomoeda CK. Arizona Battery for Communication Disorders of Dementia. Tucson: Canyonlands Publishing; 1994.

[49] Erez ABH, Rothschild E, Katz N, Tuchner M, Hartman-Maeir A. Executive Functioning, Awareness, and Participation in Daily Life After Mild Traumatic Brain Injury: A Preliminary Study. Am J Occup Ther 2009; 63:634-640.

[50] Powell JM, Temkin NR, Machamer JE, Dikmen SS. Gaining Insight Into Patients' Perspectives on Participation in Home Management Activities After Traumatic Brain Injury. Am J Occup Ther2007; 61:269-279.

[51] Hartman-Maeir A, Katz N, Baum CM. Cognitive Functional Evaluation (CFE) Process for Individuals with Suspected Cognitive Disabilities. Occup Ther Health Care 2009;23:1-23.

[52] Katz N, Itzkovich M, Averbuch S, Elazar B. Loewenstein Occupational. Therapy Cognitive Assessment (LOTCA) battery for brain-injured patients: reliability and validity. Am J Occup Ther 1989;43:184-192.

[53] Brayman SJ, Clark GF, DeLany JV, et al. Commission on Practice. Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. Am J Occup Ther 2009;63: 797-803.

[54] Mega MS, Cummings JL. Frontal-subcortical circuits and neuropsychiatric disorders. J Neuropsychiatry Clin Neurosci 1994;6:358-370.

[55] Marin R, Chakravorty S. Disorders of diminished motivation. In: Silver JM, McAllister TW, Yudofsky SC, eds. Textbook of Traumatic Brain Injury. 1st ed. Washington, DC: American Psychiatric Pub; 2005:343.

[56] Wroblewski BA, Joseph AB, Cornblatt RR. Antidepressant pharmacotherapy and the treatment of depression in patients with severe traumatic brain injury: a controlled, prospective study. J Clin Psychiatry 1996;57:582-587.

[57] Lee H, Kim SW, Kim JM, Shin IS, Yang SJ, Yoon JS. Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injury. Hum Psychopharmacol 2005;20:97-104.

[58] Sawyer E, Mauro LS, Ohlinger MJ. Amantadine enhancement of arousal and cognition after traumatic brain injury. Ann Pharmacother 2008; 42:247-252.

[59] Tenovuo O. Central acetylcholinesterase inhibitors in the treatment of chronic traumatic brain injury-clinical experience in 111 patients. Prog Neuropsychopharmacol Biol Psychiatry 2005;29:61-67.

[60] Pope HG Jr, McElroy SL, Satlin A, Hudson JI, Keck PE Jr, Kalish R. Head injury, bipolar disorder, and response to valproate. Compr Psychiatry 1988; 29:34-38.

[61] Fujii D, Ahmed I. Psychotic disorder following traumatic brain injury: a conceptual framework. Cogn Neuropsychiatry 2002;7:41-62.

[62] Sachdev P, Smith JS, Cathcart S. Schizophrenia-like psychosis following traumatic brain injury: a chart-based descriptive and case-control study. Psychol Med 2001;31:231-239.

[63] McAllister TW, Ferrell RB. Evaluation and treatment of psychosis after traumatic brain injury. NeuroRehabilitation2002;17:357-368.

[64] Hoffman AN, Cheng JP, Zafonte RD, Kline AE. Administration of haloperidol and risperidone after neurobehavioral testing hinders the recovery of traumatic brain injury-induced deficits. Life Sci 2008;83:602-607.

[65] Carroll LJ, Cassidy JD, Peloso PM, et al; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004;(43, Suppl):84-105.

[66] Silver JM, Koumaras B, Chen M, et al. Effects of rivastigmine on cognitive function in patients with traumatic brain injury. Neurology 2006; 67:748-755.

[67] Gualtieri CT, Evans RW. Stimulant treatment for the neurobehavioural sequelae of traumatic brain injury. Brain Inj1988;2:273-290.

[68] Silver JM, Yudofsky SC, Anderson KE. Aggressive disorders. In: Silver JM, McAllister TW, Yudofsky SC, eds. Textbook of Traumatic Brain Injury. 1st ed. Washington, DC: American Psychiatric Pub lishing Inc; 2005:261.

[69] Grafman J, Schwab K, Warden D, Pridgen A, Brown HR, Salazar AM. Frontal lobe injuries, violence, and aggression: a report of the Vietnam Head Injury Study. Neurology1996;46: 12 31-1238.

[70] Warden DL, Gordon B, McAllister TW, et al; Neurobehavioral Guidelines Working Group. Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury. J Neurotrauma2006; 23:1468-1501.

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