Psychosocial functioning during the year following severe traumatic brain injury

Quality of life after traumatic brain injury: a review of research approaches and findings11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To assess existing knowledge of quality of life (QOL) of people with traumatic brain injury (TBI) and to make recommendations for methodologic and substantive research in this area.

DATA SOURCES

Published research on QOL of persons with TBI, identified from databases, ancestry search, and the author's files.

STUDY SELECTION

Empirical, theoretical, and methodologic articles relevant to 5 areas: QOL as achievements, QOL as subjective well-being (SWB), QOL as utility, QOL experienced, and QOL measurement instruments applicable to TBI or specifically developed for people with this impairment.

DATA EXTRACTION

Selection of QOL indicators, with focus on TBI versus non-TBI differences.

DATA SYNTHESIS

Studies of QOL as achievements show that in almost all areas, people with TBI score lower than they did before injury and lower than comparisons groups. There are limited gaps in our knowledge in this area. Research into QOL as SWB shows that after TBI, people typically report, for example, somewhat lower life satisfaction and affect than do comparison groups, and that injury severity is not necessarily a predictor of SWB. There are almost no studies of QOL as utility of life after TBI.

CONCLUSIONS

Major research recommendations include: exploring the ability of TBI subjects to self-report; determining the salience of domains of life for this group; developing utility instruments that are sensitive to differences in deficits in cognition and other health and life domains; and doing qualitative studies that explore the experience of QOL.

Therapeutic effects of milnacipran (serotonin noradrenalin reuptake inhibitor) on depression following mild and moderate traumatic brain injury

BACKGROUND

The present study investigated the efficacy and safety of milnacipran, a serotonin noradrenalin reuptake inhibitor (SNRI), for the treatment of depression following mild and moderate traumatic brain injury (MMTBI). While other reports have been published on the use of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclics for the treatment of depression following MMTBI, no previous study has examined the use of a SNRI for this condition.

METHODS

A six-week open study was conducted using 10 patients (4 males and 6 females) of ages ranging from 28 to 74 years. DSM-IV (diagnostic statistical manual of mental disorders, 4th Ed. American psychiatric association, 1994) was used to diagnose mood disorders. The severity of depression was measured with the 21-item Hamilton rating scale for depression (HAM-D). The cognitive state of the patients was assessed using the mini-mental state examination (MMSE).

RESULTS

The maximum daily milnacipran dosage for the patients ranged from 30 to 150 mg. One patient experienced side effects, but none of the side effects were serious. On the basis of having a decrease in a final HAM-D score of more than 50%, the response rate for the nine patients was 66.7%, while in a final score of 7 or less, the remission rate for the nine patients was 44.4%. Furthermore, significantly greater improvement in cognitive function was seen in patients treated with milnacipran.

CONCLUSION

The results demonstrated that milnacipran is a safe and effective drug for depression following mild and moderate TBI and could be the first choice drug for the treatment of this condition.

Crisis and its assessment after brain injury

PRIMARY OBJECTIVE

To develop a measure to assess crisis after acquired brain injury (ABI).

RESEARCH DESIGN

A triangulated research strategy, using both qualitative and quantitative methods, was employed to develop the crisis measure.

METHODS AND PROCEDURES

The measure was developed in two phases. In the first phase, by using focus group methodology, the experience of crisis following brain injury was described. The second phase involved developing the questionnaire items, pilot testing the measure and conducting initial reliability testing.

MAIN OUTCOMES AND RESULTS

The six themes derived from the content analysis led to the creation of the measure, with versions for individuals who have an ABI, family members and professionals. Test-re-test reliability results (n = 40) were adequate.

CONCLUSIONS

The results suggest that crisis is experienced as precarious homeostasis with individuals with brain injury, varying in intensity over time, subjectively viewed as never really absent.