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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ETraumatic brain injury (TBI) has become the hallmark injury of both the Iraq and Afghanistan wars, and as compared with previous conflicts, the chances of surviving a TBI have greatly improved. However, the numbers of soldiers with TBIs, described as \u201cstaggering\u201d by the media, believe the true scope of the problem. According to data from the Centers for Disease Control (2004) civilians sustain an estimated 1.4 million TBIs annually in the US, resulting in 50,000 fatalities, 235,000 hospitalizations, and 1.1 million patients who are treated and then released from the ER to an uncertain future.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eanxiety disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esubstance-related disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurodevelopmental disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emood disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ETraumatic brain injury (TBI) has become the hallmark injury of both the Iraq and Afghanistan wars, and as compared with previous conflicts, the chances of surviving a TBI have greatly improved. However, the numbers of soldiers with TBIs, described as \u201cstaggering\u201d by the media, belie the true scope of the problem. According to data from the Centers for Disease Control (2004) civilians sustain an estimated 1.4 million TBIs annually in the US, resulting in 50,000 fatalities, 235,000 hospitalizations, and 1.1 million patients who are treated and then released from the ER to an uncertain future. \u201cWe see miracles every day,\u201d said Ross Bullock, MD, PhD, University of Miami, Miami, FL. \u201cBut it\u0027s very difficult to predict how these patients will turn out.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAs physical disabilities improve over time, psychological symptoms emerge: 10% to 20% of TBI patients develop post-traumatic stress disorder; 5% to 15% develops anxiety disorders; 9% engages in substance abuse; and as many as 15% will experience major depression. \u201cFor severe TBI, over one-third will have some degree of depression, and it\u0027s often the depression rather than the physical sequelae that holds these people back from returning to a normal life.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ECompounding issues related to a proper diagnosis and treatment of TBI-induced psychopathology is the fact that many traumas go unrecognized or are underappreciated; these injuries generally are described as \u201cmild\u201d TBI. Consider the current wartime scenario: 1.5 million men and women have served, and of these, over 25% has experienced proximity to an explosion without overt wounding. \u201cThe natural tendency amongst these soldiers is to minimize their symptoms,\u201d said Dr. Bullock, \u201cto internalize [the shock] in order to remain on duty.\u201d Many do not realize that a physical impact has actually occurred, and there are no objective tests for mild TBI.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EMany of these patients self-classify as depressed at 2 years. Personality changes, subtle and otherwise, often precipitate a decline in social behavior, which affects families and extends out into the community. \u201cWhen you do a CAT scan on those individuals, you\u0027ll usually see the hallmarks of a contusion in the limbic or temporal structures,\u201d said Dr. Bullock, though such information is not necessarily helpful. \u201cOften, they won\u0027t accept medication, and if they do, response is limited.\u201d Treatments for acute short-term behavior resolution can include trazodone, carbamazepine, or haloperidol (in that order of severity), and there are medications to avoid. \u201cI\u0027ve seen the behavioral difficulties made much worse when you try Aricept with those severe disability patients.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThere is a temptation to use lithium in TBI, but Dr. Bullock pointed out that there aren\u0027t even animal data to support its use. Lamotrigine has been suggested for depression and mood disturbance, but again, there are no TBI data, and the anticonvulsive topiramate would not be suitable because of its profound slowing effect on cognition. Sertraline has been used for TBI depression, but response rates do not exceed 30%.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EUntil more therapeutic options have been validated in the TBI setting, Dr. Bullock advised clinicians to address the most common symptom\u2014memory impairment. \u201cTell patients to keep a diary, an inventory, have them write down everything they have to do. If we could do one simple thing for these patients, it would be to improve their memory.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/3\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmeed\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}