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July 31, 2000

 

Can traumatic brain injury cause psychiatric disorders?

Baycrest psychiatrist builds argument for causation after reviewing data from available studies
Could have implications for insurance claims for rehabilitation treatment where injured party must prove their traumatic brain injury caused psychiatric disorder


Toronto, ON - It has long been suspected that a traumatic brain injury (TBI) can significantly increase the risk of major depression and other psychiatric disorders. But proving that TBI causes psychiatric disorders has been difficult.

Now a Toronto psychiatrist has conducted a review of data from published research studies over the past decade -- and used an established set of causation criteria -- to build the argument that traumatic brain injury causes a number of psychiatric disorders, including major depression, anxiety and panic attacks.

The findings of Dr. Robert van Reekum, a psychiatrist at Baycrest Centre for Geriatric Care, will be published in the summer edition of The Journal of Neuropsychiatry and Clinical Neurosciences, due out July 28th. It's the first comprehensive review of data from the 1990s and it joins a growing body of evidence that supports causation.

Dr. van Reekum conducted a MEDLINE literature search of psychiatric disorder/brain injury studies involving adults, reviewing 39 studies in all. The disorders include Major Depression, Bipolar Affective Disorder; Anxiety Disorder; Panic Disorder; Post Traumatic Stress Disorder; Schizophrenia; Substance Abuse; and Personality Disorder.

In his evaluation of each study, Dr. van Reekum applied four widely accepted causation critieria:

1. consistently demonstrating an association between the causative agent and the purported outcome;
2. demonstrating a biologic gradient (i.e. more of the causative agent causes more of the outcome);
3. demonstrating an appropriate temporal sequence (the causative agent comes first in time); and
4. providing a biologic rationale.


He found the strongest evidence for TBI causing psychiatric illness in Major Depression, Anxiety, Panic Attacks and Bipolar Disorder. While Dr. van Reekum cautions that further research is required to support his "preliminary" findings, he believes the growing body of evidence for causation will have implications for medical legal challenges.

"A person may suffer a TBI, seem to be getting better and then has a set back and can't work," says Dr. van Reekum, who has testified in court cases as an expert witness. "They may be diagnosed with depression, but when they try to seek compensation from their insurance company to pay for rehabilitation treatments, it's often not forthcoming. They are told their inability to work is due to depression rather than traumatic brain injury."

"The community needs to be aware that depression and other major psychiatric disorders are illnesses of the brain and that brain injury can cause these illnesses."