Skip to main content

Neurobehavioural symptoms one year after a head injury

  • Shoumitro Deb (a1), Ita Lyons (a1) and Charis Koutzoukis (a1)

Neurobehavioural symptoms are common immediately after a minor head injury but have not been studied one year after the injury.


To estimate the rate and pattern of neurobehavioural symptoms one year after a head injury of varying severity.


Adults who had been hospitalised after a head injury (n=196, 164 of whom had a face-to-face interview) and showed indirect evidence of brain assault were assessed for the presence of neurobehavioural symptoms with the help of a behaviour rating scale.


About 40% had three or more symptoms. Individual symptoms varied among 3% (social disinhibition), 15% (lack of initiative) and 35% (irritability) of the cohort. Premorbid factors such as lower social class and lower educational achievement, head-injury-related factors such a low Glasgow coma score, and outcome-related factors such as the presence of a disability according to the Edinburgh Rehabilitation Status Scale and psychiatric caseness according to the Clinical Interview Schedule–Revised, significantly influenced the rate and the pattern of behavioural symptoms. The pattern of symptoms varied between age groups and according to the severity of the head injury.


A significant proportion of patients with varying degrees of severity of head injury showed behavioural symptoms after one-year of head injury.

Corresponding author
Dr S. Deb, Division of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN. Tel: 01222 562323; Fax: 01222 555047; e-mail:
Hide All

Declaration of interest

Study funded by the Welsh Office.

Hide All
Affleck, J. W., Aitken, R. C. B., Hunter, J. A. A., et al (1988) Rehabilitation status: a measure of medicosocial dysfunction. Lancet, i, 230233.
Bebbington, P. E. & Nayani, T. (1995) The Psychosis Screening Questionnaire. International Journal of Methods in Psychiatric Research, 5, 1119.
Bohnen, N., Twijnstra, A. & Jolles, J. (1992) Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury. Brain Injury, 6, 481486.
Cicerone, K. D. & Kalmar, K. (1995) Persistent post-concussion syndrome; the structure of subjective complaints after mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 10, 117.
Deb, S. (1999) ICD–10 codes detect only a proportion of all head injury admissions. Brain Injury, in press.
Deb, S., Lyons, I. & Koutzoukis, C. (1998) Neuropsychiatric sequelae one year after a minor head injury. Journal of Neurology, Neurosurgery & Psychiatry 65, 899902.
Deb, S., Lyons, I. & Koutzoukis, C., et al (1999) Rate of psychiatric illness 1 year post traumatic brain injury. American Journal of Psychiatry, 156, 374378.
Fenton, G., McClelland, R., Montgomery, A., et al (1993) The postconcussional syndrome. Social antecedents and psychological sequelae. British Journal of Psychiatry, 162, 493497.
Foistein, M. F., Foistein, S. E. & McHugh, P. R. (1975) “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 89198.
Gouvier, W. D., Uddo-Crane, M. & Brown, L. M. (1988) Base rates of post-concussional symptoms. Archives of Clinical Neuropsychology, 3, 273278.
Jennett, B. & Bond, M. (1975) Assessment of outcome after severe brain damage: a practical scale. Lancet, i, 480485.
Jennett, B., Snoek, J., Bond, M. R., et al (1981) Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. Journal of Neurology, Neurosurgery and Psychiatry, 44, 285293.
Levin, H. S., Mattis, S., Ruff, R. M., et al (1987) Neurobehavioural outcome following minor head injury: a three centre study. Journal of Neurology. Neurosurgery and Psychiatry. 66, 234243.
Lewis, G., Pelosl, A. J., Araya, R. C., et al (1992) Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine, 22, 465486.
Lishman, W. A. (1988) Physiogenesis and psychogenesis in the ‘post-concussional syndrome’. British Journal of Psychiatry. 153, 460469.
McClelland, R. J., Fenton, G. W. & Rutherford, W. (1994) The post-concussional syndrome revisited. Journal of the Royal Society of Medicine, 87, 508510.
Medical Disability Society (1988) The Management of Traumatic Brain Injury London: Royal College of Physicians.
Meltzer, H., Gill, B., Petticrew, M., et al (eds) (1995) The Prevalence of Psychiatrie Morbidity Among Adults Living in Private Households: OPCS Survey of Psychiatric Morbidity in Great Britain. London: HMSO.
Nelson, M. E. (1982) National Adult Reading Test (NART). Windsor: NFER-Nelson.
Norušis, M. J. (1993) SPSS for Windows Base System Users' Guide. Release 6. 0. Chicago, IL: SPSS Inc.
Ruther ford, W., Merrett, J. D. & McDonald, J. R. (1978) Symptoms at one year following concussion from a minor head injury. Injury, 10, 225230.
Truell, J. L., Brooks, D. N., Portagase, C., et al (1994) A European chart for evaluation of patients with traumatic brain injury. In Brain Injury and Neuropsychological Rehabilitation: International Perspectives, pp. 281291. London: Lawrence Erlbaum.
Wing, J. K. Babor, T., Brugha, T., et al (1990) SCAN: Schedules for Clinical Assessment on Neuropsychiatry. Archives of General Psychiatry, 47, 586593.
World Health Organization (1978) Mental Disorders: Glossary and Guide to Their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD–9). Geneva: WHO.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 21 *
Loading metrics...

Abstract views

Total abstract views: 121 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 21st August 2018. This data will be updated every 24 hours.

Neurobehavioural symptoms one year after a head injury

  • Shoumitro Deb (a1), Ita Lyons (a1) and Charis Koutzoukis (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *