Traumatic brain injury psychiatry — structured clinical viva

This is classic CL neuropsychiatry of moderate–severe TBI: multi-syndrome presentation (depression, aggression, personality change) at the rehab interface, with capacity and driving stakes. Reject "regular risperidone" as a default personality treatment.[5][7]

Define TBI per Menon (external force + brain function alteration/pathology).[1] Severity via GCS (severe 3–8), PTA length, imaging — here severe injury with orbitofrontal contusion predicts behavioural dysregulation.[2][7]

Separate: major depression (common, outcome-linked), personality change due to medical condition, impulsive aggression, and exclude ongoing delirium/seizure/substance contribution. Note delayed psychosis can occur later but is not required here.[3][6][7]

Injury dossier, collateral, MSE with executive focus, suicide and violence risk, neuropsychology, medication review, sleep/pain. Capacity is decision-specific for SIL trial vs driving (different thresholds and external legal standards for driving fitness).[7]

Depression: sertraline evidence (Fann RCT) + therapy adapted to cognition; safety planning for SI.[3][4] Aggression: medical triggers and environment first; beta-blockers preferred class in expert reviews; short-term low-dose antipsychotic only if danger; avoid chronic high-dose risperidone for non-psychotic frontal change.[5] Multidisciplinary rehab goals; family education.

Fluent agreement ≠ capacity for complex living trial; document functional analysis; use local substitute decision law if needed. Prognosis: substantial residual risk after severe TBI; psychiatric treatment improves rehab participation; long-term psychiatric burden is well documented in follow-up literature.[3][7]

Pass: secondary nosology, sertraline trial literacy, beta-blocker priority, capacity sophistication, suicide risk. Fail: lifelong antipsychotic for personality change; ignoring medical triggers; equating orientation with capacity.[4][5][7]