6th International Congress of the WIAMH
Tuzla, Bosnia and Herzegovina, August 13 - 15, 1999.
EVALUATION OF PSYCHICAL DISORDERS AFTER CRANIO-CEREBRAL INJURIES
M. GAVRANOVIĆ, I. CERIĆ, S. RAŠIDAGIĆ, E. SULJIĆĆ
Neurological and Psychiatric Clinic of the Clinical Centre in Sarajevo
Cranio-cerebral injuries (KCP) take a special place in the clinical practice due to higher frequency and due to consequences on psychical and neurological fields. On the psychical field, the sequences can be exposed in a form of neuro-psychical deficit of a different level. With some of the traumatised, processes of remembering and perception are strongly taken, while with others are stronger the changes of personality. Evaluation of psychical disorders has to relay on some postulates that are obligatorily for all physicians and associates.
Diagnostic procedure has to start with the information on health condition before the treatment – earlier injuries and sequences of those, alcoholism, disorders in consciousness and especially psycho-pathologic exposures (medical documentation). This is rather important if the injury is not difficult, if it took place at work, if the court procedure is started. The other postulates are founded on the examination of medical documentation from the current phase of the trauma (release letter, sometimes the history of illness in extenso). We are talking of a retrospective procedure, because we need to valorise sequences with difficult KCP one or two years after the injury, and especially if those are young people (possibility of recovery is significant). Within the documentation the following needs to be taken into account – qualification of injury, length of unconscious being and posttraumatic amnesia, neurological defect. Psychic disorders, EEG, computerised tomography of brain (CTM), eventual magnetic resonance. The third postulate is a careful medical finding – neurological and psychical state (psychiatric interview) with additional findings. Neurological defect can indirectly show the difficulty of KCP. Evaluation of psychic disorders needs to start by the finding of psychiatrists and psychologist (battery of psychological tests, especially to organicites), as well as CTM (atrophy with asymmetric enlargement of commoral system, focal atrophy and contusion), and especially if demency is in question. Team and simultaneous work of all participants of the evaluation is needed, what is unfortunately not always the case in the clinical practice and therefore the mistakes are often met.
As a conclusion, we can say that the evaluation of psychical disorders after the KCP is rather complex and delicate, and that it relays on certain postulates, which are obligatory for all participants. Only and overall examination and critical judgement of all named factors can provide fundaments for a correct level of cerebral dysfunction.Key words: Cranio-cerebral Injury – Psychical Disorder – Doctrinaire Approach
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