Each year in the United States, more than 3 million people sustain traumatic brain
injury (TBI). In this population, the psychosocial deficits are, most frequently,
the major source of disability to the patient and of stress to the family. Patients
may have difficulties in many vital areas of functioning, including family, interpersonal,
vocational, educational, and recreational. Many people who have suffered TBI also
exhibit extreme personality changes. Because of the focus of most medical specialists
on the sensory and motor deficits and dysfunctions associated with TBI, the psychiatric
impairments often go unrecognized. Education of most mental health professionals
regarding the psychosocial sequelae of TBI is vastly insufficient. The cognitive,
emotional, and behavioral consequences of TBI range from the dramatic to the subtle;
consequently, clinicians without the requisite training and experience may not look
for or recognize these symptoms or may attribute impairments to other conditions
such as major depression or dementia. The net result is often delayed diagnosis
or failure to diagnose neuropsychiatric aspects of TBI, which, of course, leads
to inadequate or deficient treatment.
Our initial book on this topic, Neuropsychiatry of Traumatic Brain Injury,
was published in 1994. This book was the first comprehensive, data-based text on
the subject and was crafted to serve as a clinically relevant and practical guide
to the neuropsychiatric assessment and treatment of patients with TBI. In 2005,
we followed and expanded the original book with the publication of the first edition
of Textbook of Traumatic Brain Injury. That book included comprehensive reviews
of the current literature on the topic and expanded discussions of pathophysiology,
evaluation, and treatment. Since 2005, there has been a remarkable and exponential
increase in both interest and research in TBI, fueled by the recognition of TBI
as the "signature injury" in our returning soldiers from Iraq and Afghanistan. In
addition, there recently has been increased awareness of the devastating role of
TBI in association with sports such as football, ice hockey, boxing and other types
of competitive pugilism, skiing, bicycle racing, horseback riding, and many more.
Finally, with the growing access of American youths to automobiles, snowmobiles,
jet skis, and all-terrain vehicles; with the enhanced recognition by pediatricians
of child abuse; and with the aging of the U.S. population leading to increased falls
and other types of accidents among the elderly, clinicians are increasingly recognizing
that they are treating patients who have suffered neuropsychiatric concomitants
of TBI. The second edition of the Textbook of Traumatic Brain Injury was
written to address these emerging and enlarging issues.
All chapters in this textbook have been revised. We have endeavored to assemble
a group of authors who are authoritative and renowned in their areas and to use
a prominent multinational, interdisciplinary editorial board to guide the book's
conceptualization and review its ultimate content for accuracy and relevance. To
address specific issues of the care of our returning soldiers, a chapter on TBI
in the military has been added to this edition of the textbook. We have also added
a chapter on posttraumatic stress disorder (PTSD) to emphasize the common co-occurrence
of TBI and PTSD. We have made every effort to buttress all chapters with evidence
based on the most recent and best conducted research in the field. Finally, we conclude
each chapter with essential points and key references.
We hope that this book will be used by psychiatrists, neuropsychiatrists, neuropsychologists,
clinical psychologists, physiatrists, neurologists, and other medical and mental
health professionals, including residents and trainees involved in brain injury
rehabilitation. We also realize that a number of our patients who have sustained
TBI find themselves entangled in prolonged and complicated legal, financial, and
insurance-based struggles; we hope that this text provides an unbiased and sound
source of information for fair adjudications of such.
Few people read a textbook of this length from cover to cover. Most read only one
or two chapters during any particular period of time—often as a reference
to guide the treatment of a specific patient. Consequently, we have endeavored to
ensure that each chapter would be complete, readable, and relevant in itself. As
a result, there is some unavoidable overlap among chapters, but we have judged that
this was necessary from an information-retrieving standpoint and to prevent readers
from having to jump from section to section while reading about a particular subject.
This book would not have been possible without the help and support of many people.
First, we thank the chapter authors who labored diligently to produce contributions
that we consider unique, scholarly, and enjoyable to read. We also thank the members
of our editorial board who provided their informed perspectives on these chapters.
We greatly appreciate the efforts of the outstanding staff at American Psychiatric
Publishing, Inc., and especially those of Tina Coltri-Marshall, who served as our
coordinator for the myriad details—major and minor—inherent in writing
a book of this size and complexity. Expert and indefatigable in this Herculean task,
Tina has been a joy to work with.
Last, and most important, we thank our patients with TBI and their families, who
have been our greatest source of inspiration to further our knowledge on the presentation,
pathophysiology, assessment, and effective treatment of the psychiatric symptoms
and syndromes of people who have experienced TBI—and to pass this knowledge
on to others. We hope that the efforts of all who have participated in this book
will result in reducing your suffering, enhancing your recovery, and achieving fully
Jonathan M. Silver, M.D.
Thomas C. McAllister, M.D.
Stuart C. Yudofsky, M.D.