ABSTRACT
For guidance with interpreting the neuropsychiatric database, the reader will probably nd it useful to review Chapter 3, particularly the tables in Chapter 3. For the adult patient, Table 3.1 will provide topics from the general neuropsychiatric history that should be reviewed to determine the probability of preinjury cognitive issues. With respect to specic symptoms that may occur following traumatic brain injury (TBI), Table 3.2 provides guidance on taking the adult neuropsychiatric history after TBI. It is important for the clinician to catalog the pre-TBI historical issues, particularly the developmental ones, and then to focus on the post-TBI neurocognitive and behavioral symptoms that are expressed by either the patient or his or her family. As the database is an outcome of the neuropsychiatric examination, the posttrauma symptoms should be reviewed with specic focus placed on the cognitive, behavioral, and executive complaints of the patient. It is very important to review the outpatient treatments that have occurred following TBI, and Table 3.14 provides guidance in this respect. It is also important to review the capacity of the TBI patient, particularly one who has suffered a moderate-severe TBI, for completing the basic and instrumental activities of daily living. Table 3.6 lists important issues that should be within the neuropsychiatric database to review. Past medical history obtained by other treaters, or obtained by the clinician at the time of the neuropsychiatric examination, is a signicant element. Table 3.17 provides medical factors that have been linked to an increased risk of cognitive change following TBI, and these potential comorbid conditions should be sought and reviewed carefully within the neuropsychiatric database. Once a TBI develops, it may become comorbid with other serious preinjury difculties, such as increased age, presence of diabetes mellitus, premorbid psychiatric conditions, substance abuse, and so on. With respect to the posttraumatic physical issues for the patient, Table 3.18 lists medical comorbidities that should be reviewed after TBI. It will be necessary to determine if these are present and if the patient is currently receiving treatment for them. Tables 3.11 through 3.13 will enable the clinician to review the neuropsychiatric database and determine the current level of cognitive and behavioral difculties that have been expressed by the patient to other treaters. By reviewing Table 3.14, as the clinician analyzes the neuropsychiatric database, it should be fairly straightforward to determine if any of the common neurobehavioral treatments listed in that table have been provided to the patient, their outcomes, and the histories obtained by those particular treaters. Also, the common neurobehavioral treatments listed in Table 3.14 can provide to the clinician a structure for review of the database with respect to family dynamics, problems associated with demographics, and social issues, and it should also enable the clinician to understand the impact that TBI is having on his or her patient. As the clinician reviews the records of outpatient treaters, Table 3.15 should enable the clinician to determine what neuropsychopharmacological agents are currently prescribed to the patient, and this should guide the clinician who is providing the neuropsychiatric evaluation to determine the current behavioral and cognitive needs of the patient.
