Affiliations: [a] Denver Veterans Affairs Medical Center, Denver, CO, USA | [b] Division of Forensic Psychiatry, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA | [c] Neuropsychiatry Service, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA | [d] Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA | [e] Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
Correspondence:
[*]
Address for correspondence: Hal S. Wortzel, MD, VISN 19 MIRECC, Denver Veterans Hospital, 1055 Clermont Street, Denver, CO 80220, USA. Tel.: +1 303 596 8339; Fax: +1 303 370 7519; E-mail: hal.wortzel@ucdenver.edu
Abstract: Introduction:The advent of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is accompanied by substantial changes in the approach taken in this manual to traumatic brain injury (TBI) and its neuropsychiatric sequelae. Objective:This article reviews the issues pertaining to the treatment of TBI in the DSM-5, and changes relative to the outgoing DSM-IV-TR. The primary context for discussion of TBI in the DSM-5 is the section on Neurocognitive Disorders, where a basic framework is provided for the retrospective diagnosis of TBI and characterization of the clinical presentation as a Mild or Major Neurocognitive Disorder. The distinctions between these conditions rest not on the initial severity of TBI but instead on the severity of posttraumatic cognitive impairments and their effects on everyday function. The text succinctly reviews the epidemiology, phenomenology, and natural history of TBI and highlights the need to consider the differential diagnosis for persistent postconcussive symptoms. Conclusion:The approach taken to the diagnosis of TBI and its neuropsychiatric consequences in the DSM-5 is improved substantially over that of the DSM-IV-TR, and it is likely to improve the evaluations of persons with TBI by mental health professionals. However, challenges borne of this approach are likely to be revealed as it is implemented in everyday practice and will guide the development of this section of DSM-5.1.
