Mixed Subgroup of CHIT
Finally, there is a subgroup of PCCHITs
with more classical postconcussive complaints representing
the interactive and synergistic effects of physiologic,
cognitive and psychologic changes. This sub group
probably represents the greatest percentage of CHIT
patients and the group most often encountered in general
clinical practice. These patients may have focal residual
features as well. We call them MCHITs or Mixed CHIT
Syndrom$
This neuropsychiatric classification
system provides a practical, clinical based approach
for beginning the evaluation process. An understanding
of the differentiating features of CHITs can give
the health care provider more specific direction when
beginning evaluation. The predominant features of
MCHITs presented during diagnostic interviewing can
be classified and differentiated into more specific
sub categories, which can be used to determine the
specificity of the neuropsychiatric evaluation.
Most patients with primary psychiatric
illness have some seeds of previous psychiatric symptoms
in their histories. When the patient presents with
a good premorbid social history, a good work history,
and a warm and supportive family and changes in behavior
particularly abrupt changes in personality, mood,
or ability to function, occur after CHIT, the CHIT
must be considered a prime etiologic candidate. Similarly,
the patient who presents with rapid fluctuations in
mental status or rapid variable motor behavior frequently
suggests something other than the typical psychiatric
disorders - it is unusual for schizophrenics to be
hallucinating and delusional in the morning and clear
in the afternoon (Neppe , Tucker, 1989).