Psychiatric manifestations following TBI and their interactions with cognitive impairment.
| Psychiatric symptom | Estimated prevalence | Proposed mechanisms | Impact on cognitive function | Relevant references |
|---|---|---|---|---|
| Depression | High prevalence; persistent low mood, anhedonia, fatigue, sleep disturbances, reduced motivation | Chronic neuroinflammation; monoamine dysregulation; disrupted mood-regulating neural circuits | Exacerbates attention, memory, and executive deficits; further impairs functional recovery and QoL | [14, 74–76, 83] |
| Anxiety disorders | Common; generalized anxiety, panic symptoms | Limbic and prefrontal structural/functional changes; dysregulated stress response systems | Increases distractibility; reduces cognitive efficiency; compounds executive and attentional deficits | [83, 91] |
| Post-traumatic stress disorder (PTSD) | Substantial comorbidity; intrusive memories, avoidance, hyperarousal, negative mood | Dysregulated HPA axis; altered amygdala-prefrontal circuitry | Interacts with attention and memory impairments; diminishes functional outcomes | [92, 93] |
| Irritability/Aggression/Emotional dysregulation | Frequent; rapid mood shifts, impulsivity, low frustration tolerance | Disruption of fronto-limbic and orbitofrontal networks | Leads to social isolation, interpersonal difficulties, caregiver burden; co-occurs with depression/anxiety | [86, 94] |
| Cognitive-psychiatric interaction | Bidirectional interplay between cognitive and psychiatric symptoms | Executive dysfunction, slowed processing, attentional deficits impair emotional regulation | Psychiatric disorders exacerbate cognitive deficits, creating a cycle affecting functional independence and QoL | [86] |
The table summarizes the major psychiatric symptoms observed after traumatic brain injury (TBI), including prevalence, clinical features, proposed neurobiological mechanisms, and their impact on cognitive function and daily functioning. The bidirectional interactions between cognitive deficits and psychiatric disturbances are highlighted, emphasizing the importance of integrated assessment and rehabilitation strategies. HPA: hypothalamic-pituitary-adrenal; QoL: quality of life.
During the preparation of this work, the authors used AI-assisted graphical drafting tools (Gemini 3 Flash and ChatGPT-OpenAI) to generate Figures. After utilizing the tool, the authors reviewed and edited the content as necessary and take full responsibility for the final content of the publication.
GV: Validation, Supervision, Methodology, Visualization, Writing—review & editing, Project administration. ST: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. GM: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. EA: Data curation, Investigation, Formal analysis. DT: Conceptualization, Investigation. All authors read and approved the submitted version.
The authors declare that there are no conflicts of interest.
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