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Am J Psychiatry 1992; 149:918-923
Copyright © 1992 by American Psychiatric Association
Depression in patients with acute traumatic brain injury
JP Fedoroff, SE Starkstein, AW Forrester, FH Geisler, RE Jorge, SV Arndt and RG Robinson
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Md.
OBJECTIVE: This study was undertaken to examine patients with closed head
injuries for the presence of depressive disorders. METHOD: A consecutive
series of 66 patients with closed head injuries but no significant spinal
cord or other organ system injury were examined by means of a
semistructured psychiatric interview. The Hamilton Rating Scale for
Depression as well as scales measuring impairment in activities of daily
living, intellectual functioning, and social functioning were administered.
The patients' CT scans were also examined. RESULTS: Seventeen patients had
major depression and two had minor depression. The presence of left
dorsolateral frontal lesions and/or left basal ganglia lesions and, to a
lesser extent, parietal- occipital and right hemisphere lesions was
associated with an increased probability of developing major depression.
Compared to the nondepressed group, the group with major depression had a
higher frequency of previous psychiatric disorder and showed evidence of
poorer social functioning. CONCLUSIONS: Major depression occurs in about
one-quarter of patients after traumatic brain injury. This is the same
frequency as in other major disorders such as stroke. Major depression
appears to be provoked by one or more factors that include poor premorbid
social functioning and previous psychiatric disorder or injury to certain
critical brain locations.
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