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Traumatic brain injuries: Forensic and expertise aspects
Vulekovi? Petar,Simi? Milan,Mi?i?-Pavkov Gordana,Cigi? Tomislav
Medicinski Pregled , 2008, DOI: 10.2298/mpns0810471v
Abstract: Introduction. Traumatic brain injuries have major socio-economic importance due to their frequency, high mortality and serious consequences. According to their nature the consequences of these injuries may be classified as neurological, psychiatric and esthetic. Various lesions of brain structures cause neurological consequences such as disturbance of motor functions, sensibility, coordination or involuntary movements, speech disturbances and other deviations, as well as epilepsy. Psychiatric consequences include cognitive deficit, emotional disturbances and behavior disturbances. Criminal-legal aspect of traumatic brain injuries and litigation. Criminal-legal aspect of traumatic brain injuries expertise understands the qualification of these injuries as mild, serious and qualified serious body injuries as well as the expertise about the mechanisms of their occurrence. Litigation expertise includes the estimation of pain, fear, diminished, i.e. lost vital activity and disability, esthetic marring, and psychological suffer based on the diminished general vital activity and esthetic marring. Competence and timing of expertise. Evaluation of consequences of traumatic brain injuries should be performed only when it can be positively confirmed that they are permanent, i.e. at least one year after the injury. Expertise of these injuries is interdisciplinary. Among clinical doctors the most competent medical expert is the one who is in charge for diagnostics and injury treatment, with the recommendation to avoid, if possible, the doctor who conducted treatment. For the estimation of general vital activity, the neurological consequences, pain and esthetic marring expertise, the most competent doctors are neurosurgeon and neurologist. Psychological psychiatric consequences and fear expertise have to be performed by the psychiatrist. Specialists of forensic medicine contribute with knowledge of criminal low and legal expertise.
Psychiatric disorders and traumatic brain injury  [cached]
Marcelo Schwarzbold,Alexandre Diaz,Evandro Tostes Martins,Armanda Rufino
Neuropsychiatric Disease and Treatment , 2008,
Abstract: Marcelo Schwarzbold1, Alexandre Diaz1, Evandro Tostes Martins2, Armanda Rufino1, Lúcia Nazareth Amante1,3, Maria Emília Thais1, Jo o Quevedo4, Alexandre Hohl1, Marcelo Neves Linhares1,5,6, Roger Walz1,61Núcleo de Pesquisas em Neurologia Clínica e Experimental (NUPNEC), Departamento de Clínica Médica, Hospital Universitário, UFSC, Florianópolis, SC, Brazil; 2Unidade de Terapia Intensiva, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; 3Departamento de Enfermagem, UFSC, Florianópolis, SC, Brazil; 4Laboratório de Neurociências, UNESC, Criciúma, SC, Brazil; 5Departamento de Cirurgia, Hospital Universitário, UFSC, Florianópolis, SC, Brazil; 6Centro de Cirurgia de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos, Florianópolis, SC, BrazilAbstract: Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients’ care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed.Keywords: psychiatric disorders, traumatic brain injury, neuropsychiatry, diagnostic, epidemiology, pathophysiology
Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders  [PDF]
David O. Keyser,Scott A. Wylie
Frontiers in Neurology , 2013, DOI: 10.3389/fneur.2013.00091
Abstract: Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant’s clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.
Psychiatric sequelae of traumatic brain injury: Retrospective analysis of 75 subjects from Kaduna, Nigeria
FT Nuhu, AJ Yusuf
Nigerian Journal of Clinical Practice , 2012,
Abstract: Objective: Traumatic brain injury (TBI) is a public health problem and is associated with many complications. However little is known about the psychiatric sequelae of TBI in Nigeria. This study described the pattern and determinants of psychiatric sequelae among subjects with TBI. Materials and Methods: The study is a retrospective review of cases of subjects referred to Federal Neuropsychiatric Hospital, Kaduna on account of TBI or its complications from 2001 to 2008. Information obtained included the sociodemographic characteristics, type of injury, durations of unconsciousness (LOC) and posttraumatic amnesia (PTA), psychiatric and psychoactive substance use history. Psychiatric diagnosis was based on the criteria of the 10th edition of the International Classification of Diseases (ICD-10) Results: Mean age of the subjects was 32.2 ± 35.8 years, mean duration of unconsciousness was 6.88 ± 9.40 days, mean duration of PTA was 5.45 ± 8.78 days, 90.7% were males, 69.3% had road traffic accident (RTA), 28.0% had psychosis, 25.3% had cognitive impairment while 17.3%, 8.0%, and 6.7% had epilepsy, personality change and depression respectively. About 15% had no complications yet. Only 30.7% did cranial CT scan. Long duration of LOC and PTA were significantly associated with psychiatric complications (P value <0.05). Conclusions: Psychiatric sequelae are common after TBI. Long periods of LOC and PTA are predictive of such sequelae. Efforts should be made to prevent RTA, communal clashes and other activities that can lead to TBI.
Functional brain study of chronic traumatic head injury.  [cached]
Ceballos Alonso, Concepción,Pelegrín Valero, Carmelo,,Córdoba Díaz de Laspra, Elena
Alasbimn Journal , 2000,
Abstract: Explosive aggressive behaviour is a significant clinical and medico-legal problem in patients suffering from head injury. However, experts in neuropsychiatry have proposed a specific category for this disorder: the "organic aggressive syndrome:". The basic reason for proposing this diagnosis is that it describes the specificity of the violent conduct secondary to "brain damage" with greater precision.Early diagnosis and treatment of the injury is critical. The impact of technetium-99m-hexamethylpropuleneamine oxime (HMPAO) was examined for measuring brain damage in correlation to neuropsychological performance in patients with traumatic brain injury (TBI).We thus report the case of a twelve-year-old child with a history of CET, who presents with serious episodes of heteroaggressiveness and suggest the usefulness of single photon emission computerized tomography (SPECT) to establish the validity of this psychiatric diagnosis. The appearance of modern functional neuro-image techniques (SPECT) may help to increase the validity of clinical diagnoses in the field of psychiatry in general and of forensic psychiatry in particularly, as the related findings may be used as demarcation criteria to establish syndromic diagnoses
The Recognition of Forensic Psychiatric Expertise in European Union
Ion Rusu
EIRP Proceedings , 2012,
Abstract: In this paper we examine the internal and European provisions governing the institution ofrecognizing the forensic psychiatric expertise in the European Union, based on the European and internallegislation in the field. We previously conducted research on the recognition of judgments and judicialforeign acts emanating from another Member State, research that have resulted in studies and articlespublished in national or international specialized journals or proceedings. The work is useful for practitionerswho work in this area, and also for those interested in researching this institution. The essential contributionof this paper consists of the examination of the institution recognition in the light of the national and theEuropean legislation, the critical observations relating to certain provisions of the European legislative actsand proposals for completing and amending the European legal instruments.
S.M. Tabatabaei,A. Seddighi
Iranian Journal of Child Neurology , 2007,
Abstract: Minor trauma to the head is common in childhood and does not require any medical or surgical treatment. Nevertheless, head injury in infancy and childhood is the single most common causeof death and permanent disability. Measurabledeficits occur even after mild to moderate head injury but aremarkedly greater after severe injury. They include impairedcognition, motor impairments, disruption of attention and informationprocessing, and psychiatric disturbances. Despite the frequency of the sequelae of head injury in childhood, there is relatively little information about the structuralbasis of the clinical deficits. Classical literature suggests that the immature brain and its coverings, at a time when it is rapidly acquiring new information, respond differently from the adult brain when subjected to an equivalent amount of mechanicalforce, whether mediated by contact or inertial loading. Identification of different patterns of injury in differentage groups has resonance in clinical practice and now providesa reference point for future clinical and neuropathologicalstudies. This work not only provides the basis for the futuremanagement of patients, but also serves to remind us of thecontinuing value of the autopsy and the proper examination of retained organs using modern standardized techniques.
A pilot study examining effects of group-based Cognitive Strategy Training treatment on self-reported cognitive problems, psychiatric symptoms, functioning, and compensatory strategy use in OIF/OEF combat veterans with persistent mild cognitive disorder and history of traumatic brain injury  [PDF]
Marilyn Huckans, PhD,Shital Pavawalla, PhD,Theresa Demadura, MA,Michael Kolessar, MSD
Journal of Rehabilitation Research and Development , 2010, DOI: 10.1682/jrrd.2009.02.0019
Abstract: We aimed to determine whether group-based Cognitive Strategy Training (CST) for combat veterans with mild cognitive disorder and a history of traumatic brain injury (TBI) has significant posttreatment effects on self-reported compensatory strategy usage, functioning, and psychiatric symptoms. Participants included 21 veterans returning from conflicts in Iraq or Afghanistan with a diagnosis of Cognitive Disorder, Not Otherwise Specified and a history of combat-related TBI. Participants attended 6- to 8-week structured CST groups designed to provide them training in and practice with a variety of compensatory cognitive strategies, including day planner usage. Of the participants, 16 completed pre- and posttreatment assessment measures. Following CST, participants reported significantly increased use of compensatory cognitive strategies and day planners; an increased perception that these strategies were useful to them; increased life satisfaction; and decreased depressive, memory, and cognitive symptom severity. Group-based CST is a promising intervention for veterans with mild cognitive disorder, and randomized controlled trials are required to further evaluate its efficacy.
Time dysperception perspective for acquired brain injury  [PDF]
Federica Piras,Fabrizio Piras,Valentina Ciullo,Emanuela Danese,Carlo Caltagirone,Gianfranco Spalletta
Frontiers in Neurology , 2013, DOI: 10.3389/fneur.2013.00217
Abstract: Distortions of time perception are presented by a number of neuropsychiatric disorders. Here we survey timing abilities in clinical populations with acquired brain injuries in key cerebral areas recently implicated in human studies of timing. We purposely analyzed the complex relationship between cognitive and contextual factors involved in time estimation, as to characterize the correlation between timed and other cognitive behaviors in each group. We assume that interval timing is a solid construct to study cognitive dysfunctions following brain injury, as timing performance is a sensitive metric of information processing, while temporal cognition has the potential of influencing a wide range of cognitive processes. Moreover, temporal performance is a sensitive assay of damage to the underlying neural substrate after a brain insult. Further research in neurological and psychiatric patients will definitively answer the question of whether time distortions are manifestations of cognitive and behavioral symptoms of brain damage and definitively clarify their mechanisms.
Manuel Vilari?o,Ramón Arce,Francisca Fari?a
European Journal of Psychology Applied to Legal Context , 2013,
Abstract: Forensic evaluation of psychological injury involves the use of a multimethod approximation i.e., a psychometric instrument, normally the MMPI-2, and a clinical interview. In terms of the clinical interview, the traditional clinical interview (e.g., SCID) is not valid for forensic settings as it does not fulfil the triple objective of forensic evaluation: diagnosis of psychological injury in terms of Post Traumatic Stress Disorder (PTSD), a differential diagnosis of feigning, and establishing a causal relationship between allegations of intimate partner violence (IPV) and psychological injury. To meet this requirement, Arce and Fari a (2001) created the forensic-clinical interview based on two techniques that do not contaminate the contents i.e., reinstating the contexts and free recall, and a methodic categorical system of contents analysis for the diagnosis of psychological injury and a differential diagnosis of feigning. The reliability and validity of the forensic-clinical interview designed for the forensic evaluation of psychological injury was assessed in 51 genuine cases of (IPV) and 54 mock victims of IPV who were evaluated using a forensic-clinical interview and the MMPI-2. The result revealed that the forensic-clinical interview was a reliable instrument (α = .85 for diagnostic criteria of psychological injury, and α = .744 for feigning strategies). Moreover, the results corroborated the predictive validity (the diagnosis of PTSD was similar to the expected rate); the convergence validity (the diagnosis of PTSD in the interview strongly correlated with the Pk Scale of the MMPI-2), and discriminant validity (the diagnosis of PTSD in the interview did not correlate with the Pk Scale in feigners). The feigning strategies (differential diagnosis) also showed convergent validity (high correlation with the Scales and indices of the MMPI2 for the measure of feigning) and discriminant validity (no genuine victim was classified as a feigner). Notwithstanding, feigning strategies failed to correctly classify all of the feigners indicating they must be complemented with other measures (multimethod approximation) to meet the requirements of forensic settings.
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