A case of post-brain injury syndrome with silent state as the main manifestation1 Summary of the case Zhao Shengjun, Clinical Psychology Department, Changshu Mental Health Center The patient was a male, 36 years old, married. The patient was discharged from the hospital after recovering from a car accident in June 2001 with an “intracranial hematoma” and was in a coma for 2 days and awakened after resuscitation, after which he developed a transient mental abnormality with paroxysmal disorganized behavior and urination and defecation. After discharge, the patient was particularly introverted and withdrawn, unable to manage relationships with colleagues, and had little communication with her parents. He kept changing jobs because of the difficulty in performing his job. By 2008, the patient became significantly abnormal, reluctant to work and rarely talking to people. His behavior was bizarre, and he had twice run away from home due to minor family quarrels, resulting in a penniless and dirt-covered situation, and was sent home by the police. In 2010, the patient was treated in a psychiatric hospital, and no significant abnormality was found in the re-examination of the “cranial CT”, and the patient improved after taking “venlafaxine” and “olanzapine”, but did not return to a normal state. The patient improved after taking venlafaxine and olanzapine, but did not return to a normal state. Later, he stopped taking the medication on his own, and his symptoms further worsened. In the past year, the patient did not open his mouth to say anything, and has been staying at home, playing computer and online games, and can take care of himself. His family felt that he was mentally abnormal and sent him to our hospital in January 2014. Past history: Except for a history of head trauma in 2001, the patient had no special history. He had an introverted personality with few words before the disease. There was no obvious abnormality in the physical examination on admission, and the essence examination: the patient was clear conscious, showed a state of silence, was silent during the whole mental examination, had a pleasant demeanor, shaking his legs from time to time, and occasionally glanced at the doctor. After admission to the hospital, the patient was treated with sulpiride as the main medication and psychological intervention, and the patient began to talk and could communicate with his family for one week of treatment.2 Discussion Post-brain injury syndrome refers to the fact that 3 months after brain injury, the patient still has headache, dizziness, hysteria-like episodes and other vegetative dysfunction or psychiatric symptoms, and there are no exact positive signs in neurological examination, or even no obvious abnormal findings through CT, MRI and other examinations. There is no definite conclusion as to whether the cause is organic or functional. At present, it is believed that the pathological basis of minor cranial organic lesions, together with the personal and social factors of the patient, may have contributed [1], and that the quality and psychological factors play a leading role in the etiology [2]. The patient in this case had a relatively introverted and withdrawn personality, but was generally well adjusted socially. After the trauma, he gradually became more withdrawn and less verbal, and had difficulty communicating with others, eventually developing into silence. At the same time, the patient’s ability to take care of himself was not affected, and his facial expressions were pleasant. From the viewpoint of clinical manifestations, it was similar to the manifestations of hysterical mutism, but looking at the medical history, the patient had no obvious psychological stress factors, and his condition developed gradually, so his mutism was considered to be a manifestation of post-brain injury syndrome. Post-brain injury syndrome is usually characterized by headache and dizziness, but it is not common to see a patient with silence as the main manifestation, which may be related to the patient’s personality characteristics of being withdrawn and less talkative. In addition, the patient’s illness lasted for more than 12 years, and the whole course of the illness was deteriorating, and the patient’s social function was obviously impaired, suggesting that without active intervention, the post-brain injury syndrome will continue to develop and cause serious harm and suffering to the patient and his family. References: 1. Wu Chengyuan, Liu Yuguang. Clinical neurosurgery [M]. Beijing: People’s Health Publishing House, 2001: 219-220. 2. Shen Yu. Psychiatry (4th edition) [M]. Beijing: People’s Health Publishing House, 2001: 308. Unit: Department of Psychiatry, Changshu Third People’s Hospital Author: Zhao Shengjun Yang Zhong Xue Lian Postal Code: 215500 Email: [email protected]