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Chapter 4

PSYC32H3 Chapter Notes - Chapter 4: Antibody, Sarin, Analog Science Fiction And Fact


Department
Psychology
Course Code
PSYC32H3
Professor
Zachariah Campbell
Chapter
4

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PSYC31H3 Week 3 Notes on Chapter 4
Traumatic Brain Injury/ Head Injury:
One of the most common and severe difficulties for an individual to experience is a
traumatic brain injury (TBI). The peak ages for TBI are in the 15-24 year range. People
older than 64 years and children, younger than the age of 5 are the next groups most at
risk for TBI. Males sustain TBI at a far greater rate than females except in the older-than-
64 age range and children younger than age 5.
TBI can result from a myriad of causes and the actual TBI tends to be classified as either
an open or a closed head injury.
The severity of a TBI, whether caused by an open or closed head injury is usually
measured by a combination of the following factors:
(a) Length of posttraumatic amnesia (PTA), the period between receiving a head
injury and regaining continuous day-to-day memory for events.
(b) Depth of unconsciousness usually measured immediately after resuscitation
using the Glasgow Coma Scale (GCS).
(c) Length of unconsciousness and/or presence of neurological signs.
The GCS measures depth of coma through determining the individual’s
responsiveness level in eye opening, motor movement, and verbal
communication. Scores on the GCS range from 3-15, with higher scores
indicating more intact functioning. Scores 3-8 are classified as having a severe
TBI and those scores of 9-12 having moderate TBI.
Open Head Injury:
Open Head Injury: A brain injury which occurs when an object penetrates the skull and
exposes the brain to the elements.
The most common cause is a gunshot wound, but any object sharp enough to pierce the
skull and expose the cortex may cause an open head injury. In addition, the force behind
an object can make many nonlethal objects potentially lethal (pens, pencils, keys or any
sharp objects).
The amount of damage in an open head injury is related to the amount of energy exerted
on the brain. An object that penetrates the brain and fragments causing internal ricochet
or debris to be driven durther into the brain is likely to cause more brain involvement.
Clean wounds cause less damage than those with more brain involvement. A clean
wound implies that the damage is mainly along the path of the invading object.
Secondary effects of open head injuries may include hypotension (low blood pressure),
hypovolemia (low blood volume), contusions, and intracranial hematomas.

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Neuropsychological difficulties with open head injuries include specific cognitive deficits
and behavioural changes related to the site of the lesion. In addition, patients tend to
show the effects of general diffuse brain impairment, such as difficulties with
concentration, attention, memory, and overall mental slowing.
Prevention and treatment of infection I also crucial because the brain has been exposed
to the elements. Open head injury is highly related to epilepsy, with estimates of 80% of
patients experiencing seizures within the first 24 hours.
Closed Head Injury:
Closed Head Injury: Impact from an accident or injury causes brain damage but does not
penetrate the skull.
Coup: The initial impact in a traumatic brain injury as an object or event impinges on the
skull covering the brain.
Contrecoup: Secondary impact in a traumatic brain injury as the brain ricochets back
and forth or side to side within the skull.
Stronger force applied to the brain has the potential for greater damage. Primary
difficulties include diffuse white matter damage, contusion (bruising), and hemorrhage.
Diffuse axonal injury is caused by the acceleration and deceleration of the brain
impacting against the skull. Contusions often occur under the frontal and temporal poles
where the shearing forces of the brain are impacting on the sharpest and most confined
parts of the skull. Contusions can also occur under the point of impact or at the
contrecoup. Hemorrhages occur when blood vessels supplying oxygen to the brain are
ruptured.
Secondary damage includes injuries resulting from hematomas, cerebral hemorrhage,
infection hydrocephalus, and anoxic damage caused by breathing difficulties or low
blood pressure. All of these difficulties may begin at the initial time of injury and lead to
secondary damage to the brain. In addition, there may be neurochemical difficulties such
as changes in neuropeptides, electrolytes, and excitatory amino acids.
The most common causal factors are moving vehicle accidents, including automobiles,
motorcycles, boats, and all-terrain vehicles (ATVs) as the source. Another major source
of closed head injury is participating in athletics and, more specifically, in sports that do
not require protective headwear such as professional boxing or soccer.
Neuropsychological difficulties for individuals with closed head injury are similar to those
with open head injury except they may be less severe. Typical symptoms include
impaired speed of information processing, difficulties with concentration and attention,
memory deficits, and problems with reaction time.
Closed head injury patients often experience behavioural and/or personality changes
subsequent to the injuries. In addition, most closed head injury patients experience
some form of depression or other emotional difficulty usually because of changes in their

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life circumstances. Another difficulty is posttraumatic stress disorder (PTSD) if the closed
head injury was caused by a trauma.
Treatment for closed head injuries is similar to open head injury in terms of the medical
needs being prominent. Very important is the need to prevent or control brain swelling.
Next, because of the myriad of psychosocial difficulties, it is often helpful to enlist the aid
of a therapist or support group. Psychoactive medications may also be necessary for
some individuals. Antidepressants have been used to alleviate the depression which
may often occur secondary to closed heard injury. A typical antipsychotics and
anticonvulsants have been used to help with anger management and behavioural
outbursts.
Postconcussion Syndrome:
Postconcussion syndrome: Constellation of physical and psychological symptoms that
may occur as a result of a medically verifiable concussion.
This involves the traits and behaviours that exist after an individual has received a TBI
caused by a concussion. Not currently listed in the DSM-IV-TR as a disorder, it is
considered a syndrome under study and will probably be included in DSM-V along with
mild neurocognitive disorder.
A concussion is primarily caused by diffuse axonal injury, where axons are damaged or
destroyed because of the forces of acceleration and deceleration acting on them and on
blood vessels.
Symptoms of concussion include loss of consciousness, PTA, and sometimes seizures.
In the spectrum of TBI, a concussion is considered mild compared to open or closed
head injury.
Neuropsychological deficits in postconcussion syndrome include attention deficits,
impaired verbal retrieval, and forgetfulness. Other symptoms reported by patients
include headaches, dizziness, irritability, sleep disturbances, and fatigue.
Other researchers suggest that the residual symptoms seen in mild TBI exist due to the
significant stress the individual was under at the time of the TBI.
Finally, genetic studies also have identified the E4 allele of ApoE thought to relate to the
risk for Alzheimer’s disease as a contributor to the severity of damage of TBI. The
supposition is that identification of E4 allele in the patient may point to a more sever
outcome.
Patients are typically given pain relievers such as nonsteroidal analgesics for headaches
and medications to relieve depression, nausea, or dizziness. Rest is advised but is only
somewhat effective.
There have been numerous instances where individuals, particularly young people and
athletes, have chosen not to seek medical help and have tried to return directly to their
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