Head Trauma Destiny: Interactions of Neuropharmacology and Personality
D. Nathan Cope
Much progress has occurred in the past 5 years in understanding the indications for and responsiveness to psychopharmacologic agents in the rehabilitation of traumatic brain-injured patients. There are definite therapeutic uses for these agents in a variety of syndromes, which have been thoroughly reviewed elsewhere. To date no formal integration of this technology advance into the overall rehabilitation plan has been made. This chapter presents such an integration and suggests that a more active role for psychopharmacologic agents is appropriate for multiple indications. Particularly overlooked in clinical practice is the use of these agents for disturbances of cognition. It is important to distinguish three distinct clinical phases of treatment of TBI: (a) emergent, (b) acute recovery, and (c) long-term or chronic phase. Each has its own risk-benefit aspects that must be considered in the decision to utilize psychopharmacologic approaches.
In keeping with the theme of a 5-year reappraisal of the state of traumatic brain injury (TBI) treatment, I begin by noting that in all significant cases, the patient is still consistently left with major functional disabilities despite the most aggressive treatment and the most optimal outcome. It is likely that some form of permanent residual also persists for minor brain injuries (which do not now routinely come to the attention of rehabilitation professionals) to some extent, although these disabilities are more subtle.