i) Types of mood disorders

There are a number of types of mood disorders that can be diagnosed following a traumatic brain injury.

The following mood disorders can be found in the DSM IV - the Diagnostic and Statistical Manual (4th Edition).

Major depressive disorder

Major depressive disorder is the characteristic severe depression. Dysthymic disorders also arise but they are a less severe characterisation of the disturbance of mood than that seen in a major depression.

Bipolar disorders

In bipolar disorders there can be a depressed phase. Bipolar can be further divided into Type 1 and Type 2. The distinguishing between Type 1 and Type 2 depends on the characterisation of the manic symptoms.

Adjustment disorder with depressed mood

Adjustment disorder with depressed mood occurs when the person has mood symptoms but some reactivity of mood.

Psychological factors are important in the genesis of this disorder.

Major depressive disorder following closed head injury

Finally the diagnosis can be a depressive disorder following a traumatic brain injury, when the clinician is convinced structural brain injury is an important aetiological factor in the illness onset.

ii) Relationship of mood disorder to brain injury

It is important to be able to identify what the relationship of the mood disorder is to the brain injury.

People may develop mood disorders very shortly after the brain injury.  In this case it is highly likely that the actual damage to the brain and the chemical changes that occur are implicated in causing the mood disorder.

In this situation we use the diagnosis of a depressive disorder following closed injury or depressive disorder following brain injury.

If a person develops a mood disorder following a brain injury two or three years later and the relationship with the actual structural injury with the brain is distant you are more likely to make the diagnosis of a major depressive disorder.  The depression is then likely a response to the stresses and changes associated with the brain injury.

There are a number of other psychiatric diagnoses that also can include predominant depressed mood but the diagnoses are different. The management may also different.

The diagnostic groups that can have significant depressive symptomatology include:

• delirium where the person can be very quiet and withdrawn and
• dementia where the predominant disturbance is that of cognitive function but they also may be very depressed and withdrawn.

In schizophrenia people can have significant depressive symptoms in the prodrome, the period of time before the onset of acute psychotic symptoms and they can also have a depressive illness subsequent to the acute psychosis.

Finally in obsessive compulsive disorders, posttraumatic stress disorder and other anxiety disorder depressed mood can be a component or a feature of these diagnoses.

It is important to make the appropriate diagnosis because the management strategies can differ substantially, for example, with that of a major depressive disorder and a delirium.

 

 

References:

1. Mood disorders following traumatic brain injury: chapter 4 : in The behavioural and emotional complications of traumatic brain injury. SF Crowe. Taylor and Francis. New York 2007.

2. Mood disorders RE Jorge, RG Robinson. Chapter 10 In; Textbook of Traumatic Brain Injury. Ed. JM Silver, TW McAllister, SC Yudofsky. American Psychiatri Press. Washington DC, 2011.

3. Clinical considerations for the diagnosis of major depression after moderate to severe TBI. RT Steel, S Macciocchi, JS Kreuter. J. Head Trauma Rehabilitation, Vol 25 (2), 99 – 112. 2010