Beyond the surface: understanding psychiatric disorders in individuals with spinal cord injury- a narrative exploration.

Abstract

Purpose: Spinal Cord Injury (SCI) presents a life-threatening condition that compromises the spinal cord's integrity. Among the complications affecting SCI patients are psychiatric disorders, whose causal mechanisms remain elusive. These disorders are often attributed to multifactorial aspects, encompassing physiological, neurobiological, psychological, and social factors. In the context of SCI patients, we are interested in identifying the specific factors that contribute to the development of psychiatric disorders in this population, emphasizing the critical need for prevention strategies and comprehensive therapeutic management, ultimately aiming to improve the affected patients' quality of life.

Methods: The process of searching and selecting information was performed between August and December of 2023, utilizing PubMed, ResearchGate, and NCBI as the requisite databases for this review. To ensure precise information retrieval, keywords were strategically employed, focusing on publications spanning from 1985 to the present. MeSH terms, including spinal cord injury, acute spinal cord injury, psychiatric disorders, neuropsychiatry, cognitive impairment, and chronic pain, were applied. A total of 127 articles were identified through electronic searches, and 55 of these were chosen for inclusion in this review. The consulted studies encompassed various types, such as meta-analyses, systematic reviews, animal model experiments, and others.

Results: Various factors contributing to the onset of psychiatric disorders in patients with SCI were proposed, all grounded in evidence: neurobiological pathology; cognitive impairment; the impact of systemic diseases on psychological well-being; and, lastly, the correlation between chronic pain and diminished daily functionality, experiences widely encountered by SCI patients.

Conclusion: The diagnosis of psychiatric disorders remains largely clinical and syndromic, with unclear causal mechanisms. Understanding psychiatric symptoms in SCI patients requires further investigation. Key contributing factors include neurobiological pathology linked to SCI, cognitive impairment, systemic and organ-specific diseases, and chronic pain associated with reduced functionality. We emphasize the importance of therapeutic and rehabilitative measures that address both physical and psychological health to improve overall quality of life.