chapter  3
64 Pages

Gathering the Neuropsychiatric History following Brain Trauma

Traditionally, psychiatry has termed the gathering of oral history from a patient in the psychiatric interview. In neuropsychiatry, the psychiatric interview takes a different path from traditional psychiatric examination. The strengths of the traditional psychiatric interview approach remain, but the examiner should focus more on cerebral dysfunction than on psychological abnormality while collecting neuropsychiatric data. While it is not precise, localization as a paradigm for a neuropsychiatric examination is more systematized scientifically than the general and traditional psychiatric symptoms.1,2

Within psychiatric medicine, the gathering of history has been the sine qua non of the practice of medicine since the time of Hippocrates.3 Within the United States, one of the signers of the Declaration of Independence, Benjamin Rush, first provided American medical practice with the schema for taking a psychiatric history while making medical inquiry of the mind.4 Gowers developed a manual for use while exploring diseases of the nervous system, which was published in the late 1880s.5 More recently, Ovsiew has provided an excellent overview of bedside neuropsychiatry, and his chapter provides a broad review of methods used for gathering neuropsychiatric data at the bedside.6 In this chapter, gathering history is separated from the mental status examination. This is unlike the traditional psychiatric interview technique, which combines the interview, history, and mental status examination.7 With regard to children, the reader is referred to Larsen.8

With particular reference to traumatic brain injury (TBI) in children, the reader is referred to Arffa.9

This exploration of gathering neuropsychiatric history following brain trauma will separate taking the adult history from the child history. The taking of history will be augmented by exploring the use of collateral historians such as parents, spouses, and caregivers. Special emphasis will be given to collecting data from the available medical records. This provides background information for the treating psychiatrist. For the forensic psychiatrist, however, reviewing records is critical in determining causation and the presence of prior cerebral disorders or brain trauma that may have a bearing on apportionment within a civil tort action. Also, in neuropsychiatry, while attention is focused on cerebral symptomatology, one must not neglect psychosocial variables, as these may have substantial impact on symptom expression, level of impairment, and disability.6 Moreover, it is important for the neuropsychiatric practitioner to remember there is no substitute for the taking of an adequate history. One should not fall prey to the use of rapidly advancing neuroimaging techniques and cognitive neuropsychology as substitutes for a complete neuropsychiatric history.