Guidelines for evaluation of psychological side-effects of brain injury

In her PhD, defended at the University of the Basque Country, Maria Luisa de Francisco Maiz provided a clinical-forensic evaluation of brain injuries and also a study on the variables that influence the length of "legal time periods".

Brain injuries are a serious problem in the industrialised countries, not only for their high incidence but also because they mainly affect young people. At a clinical level, the increase in the efficacy of intensive medical treatments has enabled a drop in the rates of mortality but this fact has generated, in turn, an increase in the number of persons affected by the consequences or after-effects of brain injury. Amongst the various consequences, the neuropsychological and neuropsychiatric ones pose the greatest difficulty for assessment and estimation/quantification of damage

The prevalence of neuropsychological and neuropsychiatric disorders amongst those affected by brain injury is very high, given that the incidence of brain damage from injuries received is between 200 and 300 cases for every 100,000 inhabitants.

The PhD of Maria Luisa de Francisco Maiz was read at the Faculty of Psychology of the University of the Basque Country (UPV/EHU) and provided a clinical-forensic evaluation of brain injuries and also a study on the variables that influence the length of “legal time periods”.

The PhD, entitled Aportaciones a la evaluación clínico-forense de secuelas neuropsiquiátricas y neuropsicológicas de los traumatismos craneoencefálicos (Contributions to a clinical-forensic evaluation of the neuropsychological and neuropsychiatric consequences of brain injuries), was led by Professor of the Department of Personality, Evaluation and Pyschological Treatment, Enrique Echeburúa Odriozola, and received First Class Honours cum laude.

Maria Luisa de Francisco Maiz is a graduate in General Medicine and Surgery from the UPV/EHU and currently directs Forensic Medicine at the Basque Institute of Legal Medicine.

After-effects and legal time periods

The main aim of this PhD was to provide a clinical-forensic evaluation of brain injuries, protocolising the evaluation and putting forward guidelines for the clinical and functional assessment of their neuropsychological and neuropsychiatric consequences.

One of the objectives of this research was to find out the variables that influence the duration of “legal time periods”: the time taken for curing, the period of disability and time of hospitalisation. These time periods are used by judges and courts to assess indemnities for corporal damage, and so, in part at least, they bear on the amount of indemnity. Corporal damage is calculated taking into account the consequences or after-effects of the brain injury: physical, neurological, neuropsychological and neuropsychiatric.

To this end, a wide-ranging review was undertaken of the theoretical aspects of the after-effects of brain injuries. With this information a protocol for a clinical-forensic evaluation to enable the diagnosis of these neuropsychological and neuropsychiatric consequences was drawn up and put forward. Likewise, a system was proposed for the evaluation of the psychological side effects corresponding to the international classifications of mental illnesses.

Main conclusions

The researcher pointed out that “in the clinical-forensic evaluation for neuropsychological and neuropsychiatric after-effects of brain injuries, the guidelines will aid the initial assessments”.

According to this study, female patients that have suffered brain injury are hospitalized for longer periods. As regards the period of curing and disability, however, there were no significant differences between the sexes.

These legal time periods are not linked to the presence or otherwise of cranial fracture but they are greater when brain damage has taken place in the left hemisphere.

“There are various limitations when evaluating the neuropsychological and neuropsychiatric consequences of brain injuries and this work is aimed at facilitating this evaluation”, Ms de Francisco Maiz concluded.