The most common causes of traumatic brain injury (TBI) are motor vehicle accidents, falls, violence, and sports and recreational activities. Severity of head injury can be determined on the basis of any combination of the following: initial Glasgow Coma Scale (GCS), the duration of loss of consciousness (LOC), and the duration of post traumatic amnesia (PTA). The underlying etio-pathogenesis of post-TBI depression is most likely multi-factorial and most likely involves biopsychosocial factors. This chapter lists out the risk factors for post-TBI depression. Several psychiatric syndromes have been reported in individuals with TBI. These include disturbances of mood, cognition, personality, and behavior. Accurate diagnosis of post-TBI major depression is arduous because a number of symptoms of major depression, particularly the neuropsychiatric symptoms, are directly related to the brain injury itself. The approach to management may follow a biopsychosocial model involving pharmacotherapy, psychotherapy, education, and support for caregivers or family members.

Two international classifications currently dominate research and clinical practise; the International Classification of Diseases (ICD)-10 and the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV. Both classifications provide detailed descriptions of all the main psychiatric syndromes, personality disorders and other disorders of behaviour or function. The first comprehensive nosology covering an entire range of diseases and including a classification of mental illness was produced by the newly formed World Health Organisation (WHO) in 1948. The WHO has the responsibility to produce regular revisions of the ICD for international use. Disorders in ICD-10 are arranged in groups according to major common themes or descriptive likenesses. DSM-IV has more categories than ICD-10, which may reflect the requirements of the health care system in the United States. The International Personality Disorder Examination (IPDE) assesses the phenomena and life experiences that are relevant to the diagnoses of personality disorders in DSM-IV and ICD-10.

This chapter identifies how postdisaster patient triage and management can incorporate behavioral/psychiatric assessment and treatment, merging behavioral and medical approaches in the differential diagnosis and early management of common psychiatric syndromes among medical-surgical disaster or terrorism casualties. A postdisaster screening examination to triage and identify early psychiatric casualties can be thought of as a tertiary survey that focuses on the most common psychiatric sequelae. Government and organizational responses play an important role in limiting psychological contagion and may help to lessen overburdening of the healthcare system after a terrorist event or disaster. In a postdisaster hospital or hospice setting, depression is common. The utility of antidepressant medications is limited by the several weeks needed for the agents to be effective. Careful management of the public education and risk communication aspects of disaster and terrorism has multiplier effects in terms of preventing inappropriate and costly utilization of healthcare resources.

This chapter begins by analyzing the associations between recurrent brief depression (RBD), recurrent brief hypomania (RBM), and recurrent brief anxiety (RBA). All three recurrent brief psychiatric syndromes share an ultrarapid cycling pattern of mood symptoms. In association with major depressive episodes (MDEs), they clearly increase impairment and worsen treatment outcomes. Given this greater clinical severity of combined depression (CD), it is reasonable to hypothesize that bipolar II (BP-II) disorders combined with RBD also represent more severe clinical conditions than pure BP-II forms. The main goal of the chapter is to test this hypothesis by comparing diagnostic subgroups of mood disorders with and without RBD in a large number of validating clinical variables, including family history, course, personality, and comorbidity. The relationship of the two mood spectra with recurrent brief psychiatric syndromes (RBD, RBM, and RBA), with particular emphasis on RBD is focused in this chapter.