Research Reports - Psychotherapeutic follow up of out patients with traumatic brain injury

Ann Phys Rehabil Med. 2012 Jun 6

Wiart L, Richer E, Destaillats JM, Joseph PA, Dehail P, Mazaux JM

Psychotherapy for affective/behaviour disorders after traumatic brain injury
(TBI) remains complex and controversial. The neuro-systemic approach aims at
broadening the scope in order to look at behaviour impairments in context of both
patient's cognitive impairments and family dysfunctioning. OBJECTIVE: To report a
preliminary report of a neuro-systemic psychotherapy for patients with TBI.
PATIENTS AND METHODS: All patients with affective/behaviour disorders referred to
the same physician experienced in the neuro-systemic approach were consecutively
included from 2003 to 2007. We performed a retrospective analysis of an at least
1-year psychotherapy regarding the evolution of the following symptoms:
depressive mood, anxiety, bipolar impairment, psychosis, hostility, apathy, loss
of control, and addictive behaviours as defined by the DSM IV. Results were
considered very good when all impairments resolved, good when at least one
symptom resolved, medium when at least one symptom improved, and bad when no
improvement occurred, or the patient stopped the therapy by himself. RESULTS:
Forty-seven patients, 35 men and 12 women, with a mean age of 33.4 years, were
included. Most suffered a severe TBI (mean Glasgow coma score: 6.4) 11 years on
average before the inclusion. At the date of the study, 11 patients (23%) had a
poor outcome, 23 (48%) suffered Moderate disability and 13 (27%) had a Good
recovery on the GOS scale. All therapy sessions were performed by the same
physician, with 10 sessions on average during 13.5 months. Results were
classified very good in six cases (13%), good in 18 others (38%), medium in 10
patients (21%) and bad in 13 cases (27%). We observed a significant improvement
of affective disorders, namely anxiety (P<0.001) depressive mood (P<0.001) and
hostility (P<0.01). However, bipolar symptomatology, apathy, loss of control and
addictive disorders did not improve. DISCUSSION/CONCLUSION: From our best
knowledge, this is the first clinical report of neuro-systemic psychotherapy for
affective/behaviour disturbances in TBI patients. This kind of therapy was shown
to be feasible, with a high rate of compliance (72%). Psycho-affective disorders
and hostility were shown to be more sensitive to therapy than other behaviour
impairments. These preliminary findings have to be confirmed by prospective
trials on broader samples of patients.

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