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Hujing CL, Yalch MM, Levendosky AA. Association Between Betrayal Trauma and the PAI Traumatic Stress Scale. J Trauma Dissociation 2024; 25:408-418. [PMID: 38385573 DOI: 10.1080/15299732.2024.2320873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/30/2023] [Indexed: 02/23/2024]
Abstract
The Personality Assessment Inventory (PAI) is among the most commonly used broadband inventories of psychological functioning. For the purposes of assessing trauma specifically, the most relevant aspect of the PAI is the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T), which measures the degree to which a person feels wounded by something in their past. Research suggests that ARD-T is associated with exposure to a variety of different traumatic stressors. However, there is little research on the degree to which traumatic stressors that entail a component of interpersonal betrayal (i.e. betrayal trauma) are associated with higher scores on ARD-T relative to other stressors. In this study, we evaluated the relative associations between traumas with varying degrees of betrayal and scores on ARD-T in a secondary analysis of two non-clinical samples (college sample N = 494; crowdsourced sample N = 364) using a Bayesian approach to multiple regression. In both samples, traumas with both high and medium (but not low) degrees of betrayal were associated with elevated ARD-T scores. Findings suggest that ARD-T scores are associated with interpersonal trauma regardless of betrayal, which has implications for interpretation of the ARD-T scale in practice.
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Affiliation(s)
| | - Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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2
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Berman R, Spencer H, Boese M, Kim S, Radford K, Choi K. Loss of Consciousness and Righting Reflex Following Traumatic Brain Injury: Predictors of Post-Injury Symptom Development (A Narrative Review). Brain Sci 2023; 13:brainsci13050750. [PMID: 37239222 DOI: 10.3390/brainsci13050750] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Identifying predictors for individuals vulnerable to the adverse effects of traumatic brain injury (TBI) remains an ongoing research pursuit. This is especially important for patients with mild TBI (mTBI), whose condition is often overlooked. TBI severity in humans is determined by several criteria, including the duration of loss of consciousness (LOC): LOC < 30 min for mTBI and LOC > 30 min for moderate-to-severe TBI. However, in experimental TBI models, there is no standard guideline for assessing the severity of TBI. One commonly used metric is the loss of righting reflex (LRR), a rodent analogue of LOC. However, LRR is highly variable across studies and rodents, making strict numeric cutoffs difficult to define. Instead, LRR may best be used as predictor of symptom development and severity. This review summarizes the current knowledge on the associations between LOC and outcomes after mTBI in humans and between LRR and outcomes after experimental TBI in rodents. In clinical literature, LOC following mTBI is associated with various adverse outcome measures, such as cognitive and memory deficits; psychiatric disorders; physical symptoms; and brain abnormalities associated with the aforementioned impairments. In preclinical studies, longer LRR following TBI is associated with greater motor and sensorimotor impairments; cognitive and memory impairments; peripheral and neuropathology; and physiologic abnormalities. Because of the similarities in associations, LRR in experimental TBI models may serve as a useful proxy for LOC to contribute to the ongoing development of evidence-based personalized treatment strategies for patients sustaining head trauma. Analysis of highly symptomatic rodents may shed light on the biological underpinnings of symptom development after rodent TBI, which may translate to therapeutic targets for mTBI in humans.
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Affiliation(s)
- Rina Berman
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD 20814, USA
| | - Haley Spencer
- Program in Neuroscience, Uniformed Services University, Bethesda, MD 20814, USA
| | - Martin Boese
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - Sharon Kim
- F. E. Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Kennett Radford
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - Kwang Choi
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD 20814, USA
- Program in Neuroscience, Uniformed Services University, Bethesda, MD 20814, USA
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
- F. E. Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
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3
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Kosaraju S, Galatzer-Levy I, Schultebraucks K, Winters S, Hinrichs R, Reddi PJ, Maples-Keller JL, Hudak L, Michopoulos V, Jovanovic T, Ressler KJ, Allen JW, Stevens JS. Associations among civilian mild traumatic brain injury with loss of consciousness, posttraumatic stress disorder symptom trajectories, and structural brain volumetric data. J Trauma Stress 2022; 35:1521-1534. [PMID: 35776892 DOI: 10.1002/jts.22858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) is prevalent and associated with significant morbidity. Mild traumatic brain injury (mTBI) concurrent with psychiatric trauma may be associated with PTSD. Prior studies of PTSD-related structural brain alterations have focused on military populations. The current study examined correlations between PTSD, acute mTBI, and structural brain alterations longitudinally in civilian patients (N = 504) who experienced a recent Criterion A traumatic event. Participants who reported loss of consciousness (LOC) were characterized as having mTBI; all others were included in the control group. PTSD symptoms were assessed at enrollment and over the following year; a subset of participants (n = 89) underwent volumetric brain MRI (M = 53 days posttrauma). Classes of PTSD symptom trajectories were modeled using latent growth mixture modeling. Associations between PTSD symptom trajectories and cortical thicknesses or subcortical volumes were assessed using a moderator-based regression. mTBI with LOC during trauma was positively correlated with the likelihood of developing a chronic PTSD symptom trajectory. mTBI showed significant interactions with cortical thickness in the rostral anterior cingulate cortex (rACC) in predicting PTSD symptoms, r = .461-.463. Bilateral rACC thickness positively predicted PTSD symptoms but only among participants who endorsed LOC, p < .001. The results demonstrate positive correlations between mTBI with LOC and PTSD symptom trajectories, and findings related to mTBI with LOC and rACC thickness interactions in predicting subsequent chronic PTSD symptoms suggest the importance of further understanding the role of mTBI in the context of PTSD to inform intervention and risk stratification.
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Affiliation(s)
- Siddhartha Kosaraju
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Isaac Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Vagelos School of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Sterling Winters
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Rebecca Hinrichs
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Preethi J Reddi
- Department of Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Lauren Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tanja Jovanovic
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kerry J Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer S Stevens
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
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Schultebraucks K, Ben-Zion Z, Admon R, Keynan JN, Liberzon I, Hendler T, Shalev AY. Assessment of early neurocognitive functioning increases the accuracy of predicting chronic PTSD risk. Mol Psychiatry 2022; 27:2247-2254. [PMID: 35082440 PMCID: PMC11129320 DOI: 10.1038/s41380-022-01445-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/24/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a protracted and debilitating consequence of traumatic events. Identifying early predictors of PTSD can inform the disorder's risk stratification and prevention. We used advanced computational models to evaluate the contribution of early neurocognitive performance measures to the accuracy of predicting chronic PTSD from demographics and early clinical features. We consecutively enrolled adult trauma survivors seen in a general hospital emergency department (ED) to a 14-month long prospective panel study. Extreme Gradient Boosting algorithm evaluated the incremental contribution to 14 months PTSD risk of demographic variables, 1-month clinical variables, and concurrent neurocognitive performance. The main outcome variable was PTSD diagnosis, 14 months after ED admission, obtained by trained clinicians using the Clinician-Administered PTSD Scale (CAPS). N = 138 trauma survivors (mean age = 34.25 ± 11.73, range = 18-64; n = 73 [53%] women) were evaluated 1 month after ED admission and followed for 14 months, at which time n = 33 (24%) met PTSD diagnosis. Demographics and clinical variables yielded a discriminatory accuracy of AUC = 0.68 in classifying PTSD diagnostic status. Adding neurocognitive functioning improved the discriminatory accuracy (AUC = 0.88); the largest contribution emanating from poorer cognitive flexibility, processing speed, motor coordination, controlled and sustained attention, emotional bias, and higher response inhibition, and recall memory. Impaired cognitive functioning 1-month after trauma exposure is a significant and independent risk factor for PTSD. Evaluating cognitive performance could improve early screening and prevention.
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Affiliation(s)
- Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
| | - Ziv Ben-Zion
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
- Departments of Comparative Medicine and Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, The Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Roee Admon
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Jackob Nimrod Keynan
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | | | - Talma Hendler
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Arieh Y Shalev
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
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Pieper J, Chang DG, Mahasin SZ, Swan AR, Quinto AA, Nichols S, Diwakar M, Huang C, Swan J, Lee R, Baker DG, Huang M. Brain Amygdala Volume Increases in Veterans and Active-Duty Military Personnel With Combat-Related Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E1-E9. [PMID: 31033749 PMCID: PMC6814512 DOI: 10.1097/htr.0000000000000492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify amygdalar volumetric differences associated with posttraumatic stress disorder (PTSD) in individuals with comorbid mild traumatic brain injury (mTBI) compared with those with mTBI-only and to examine the effects of intracranial volume (ICV) on amygdala volumetric measures. SETTING Marine Corps Base and VA Healthcare System. PARTICIPANTS A cohort of veterans and active-duty military personnel with combat-related mTBI (N = 89). DESIGN Twenty-nine participants were identified with comorbid PTSD and mTBI. The remaining 60 formed the mTBI-only control group. Structural images of brains were obtained with a 1.5-T MRI scanner using a T1-weighted 3D-IR-FSPGR pulse sequence. Automatic segmentation was performed in Freesurfer. MAIN MEASURES Amygdala volumes with/without normalizations to ICV. RESULTS The comorbid mTBI/PTSD group had significantly larger amygdala volumes, when normalized to ICV, compared with the mTBI-only group. The right and left amygdala volumes after normalization to ICV were 0.122% ± 0.012% and 0.118% ± 0.011%, respectively, in the comorbid group compared with 0.115% ± 0.012% and 0.112% ± 0.009%, respectively, in the mTBI-only group (corrected P < .05). CONCLUSIONS The ICV normalization analysis performed here may resolve previous literature discrepancies. This is an intriguing structural finding, given the role of the amygdala in the challenging neuroemotive symptoms witnessed in casualties of combat-related mTBI and PTSD.
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Affiliation(s)
- Joel Pieper
- Department of Internal Medicine, University of California, San Diego, CA, USA
| | - Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | | | - Ashley Robb Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Mithun Diwakar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Charles Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - James Swan
- Department of Management Information Systems, San Diego State University, San Diego, CA, USA
| | - Roland Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G. Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Mingxiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
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Strack JE, Torres VA, Pennington ML, Cardenas MN, Dupree J, Meyer EC, Dolan S, Kruse MI, Synett SJ, Kimbrel NA, Gulliver SB. Psychological distress and line-of-duty head injuries in firefighters. Occup Med (Lond) 2021; 71:99-104. [PMID: 33598694 DOI: 10.1093/occmed/kqab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Head injuries are common injury in the fire service; however, very little data exist on the risks this may pose to the development of post-traumatic stress disorder (PTSD) and depression in this high-risk population. AIMS Our study aimed to compare levels of PTSD and depression symptoms in firefighters with a line-of-duty head injury, non-line-of-duty head injury and no head injury. METHODS In this cross-sectional study, we assessed current PTSD and depression symptoms as well as retrospective head injuries. RESULTS Seventy-six per cent of the total sample reported at least one head injury in their lifetime. Depression symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to those with no head injury, but not compared to those who sustained a non-line-of-duty head injury. Depression symptoms did not differ between firefighters with a non-line-of-duty head injury and those with no head injury. PTSD symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to both firefighters with no head injury and those with a non-line-of-duty head injury. CONCLUSIONS We found that firefighters who reported at least one line-of-duty head injury had significantly higher levels of PTSD and depression symptoms than firefighters who reported no head injuries. Our findings also suggest head injuries sustained outside of fire service could have less of an impact on the firefighter's PTSD symptom severity than head injuries that occur as a direct result of their job.
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Affiliation(s)
- J E Strack
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - V A Torres
- University of Mississippi, University Park, Mississippi, USA
| | - M L Pennington
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - M N Cardenas
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - J Dupree
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - E C Meyer
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA.,Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Temple, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - S Dolan
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - M I Kruse
- Austin Fire Department and Austin-Travis County Emergency Medical Services, Austin, TX, USA
| | - S J Synett
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs, Denver, CO, USA
| | - N A Kimbrel
- Durham Veteran Affairs Medical Center, Durham, NC, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - S B Gulliver
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA.,Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Temple, TX, USA
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Rahmat S, Velez J, Farooqi M, Smiley A, Prabhakaran K, Rhee P, Khan M, Dornbush R, Ferrando S, Smolin Y. Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool. Trauma Surg Acute Care Open 2021; 6:e000623. [PMID: 33880413 PMCID: PMC7993304 DOI: 10.1136/tsaco-2020-000623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has debilitating psychiatric and medical consequences. The purpose of this study was to identify whether PTSD diagnosis and PTSD symptom scale score (PTSD severity) could be predicted by assessing peritraumatic experiences using a single question or screening tools at different time points in patients hospitalized after admission to the hospital after significant physical trauma, but with stable vitals (level II trauma). METHODS Patients completed the 'initial question' and the National Stressful Events Survey Acute Stress Disorder Scale (NSESSS) at 3 days to 5 days after trauma (NSESSS-1). The same scale was administered 2 weeks to 4 weeks after trauma (NSESSS-2). The Posttraumatic Stress Disorder Symptoms Scale Interview for DSM-5 (PSSI-5) was administered 2 months after trauma. PTSD diagnosis and PTSD severity were extracted from the PSSI-5. Linear multivariate regression analyses were used to establish whether scores for NSESSS-1 or NSESSS-2 predicted PTSD diagnosis/PTSD severity. Non-linear multivariate regression analyses were performed to better understand the relationship between NSESSS-1/NSESSS-2 and PTSD diagnosis/PTSD severity. RESULTS A single question assessing the experience of fear, helplessness, or horror was not an effective tool for determining the diagnosis of PTSD (p=0.114) but can be a predictor of PTSD severity (p=0.039). We demonstrate that administering the NSESSS after either 3 days to 5 days (p=0.008, p<0.001) or 2 weeks to 4 weeks (p=0.039; p<0.001) can predict the diagnosis of PTSD and PTSD severity. Scoring an NSESSS above 14/28 (50%) increases the chance of experiencing a higher PTSD severity substantially and linearly. DISCUSSION Our initial question was not an effective predictor of PTSD diagnosis. However, using the NSESSS at both 3 days to 5 days and 2 weeks to 4 weeks after trauma is an effective method for predicting PTSD diagnosis and PTSD severity. Additionally, we show that patients who score higher than 14 on the NSESSS for acute stress symptoms may need closer follow-up. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Saad Rahmat
- Department of Psychiatry and Behavioral Sciences, Westchester Medical Center, Valahlla, NY, USA
| | - Jessica Velez
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Muhammad Farooqi
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Abbas Smiley
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Kartik Prabhakaran
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Peter Rhee
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Maria Khan
- New York Medical College, St. Vincent's Medical Center, Yonkers, New York, USA
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Stephen Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Yvette Smolin
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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Roy D, Peters ME, Everett AD, Leoutsakos JMS, Yan H, Rao V, T Bechtold K, Sair HI, Van Meter T, Falk H, Vassila A, Hall A, Ofoche U, Akbari F, Lyketsos C, Korley F. Loss of Consciousness and Altered Mental State as Predictors of Functional Recovery Within 6 Months Following Mild Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2020; 32:132-138. [PMID: 31530119 DOI: 10.1176/appi.neuropsych.18120379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors tested the hypothesis that a combination of loss of consciousness (LOC) and altered mental state (AMS) predicts the highest risk of incomplete functional recovery within 6 months after mild traumatic brain injury (mTBI), compared with either condition alone, and that LOC alone is more strongly associated with incomplete recovery, compared with AMS alone. METHODS Data were analyzed from 407 patients with mTBI from Head injury Serum Markers for Assessing Response to Trauma (HeadSMART), a prospective cohort study of TBI patients presenting to two urban emergency departments. Four patient subgroups were constructed based on information documented at the time of injury: neither LOC nor AMS, LOC only, AMS only, and both. Logistic regression models assessed LOC and AMS as predictors of functional recovery at 1, 3, and 6 months. RESULTS A gradient of risk of incomplete functional recovery at 1, 3, and 6 months postinjury was noted, moving from neither LOC nor AMS, to LOC or AMS alone, to both. LOC was associated with incomplete functional recovery at 1 and 3 months (odds ratio=2.17, SE=0.46, p<0.001; and odds ratio=1.80, SE=0.40, p=0.008, respectively). AMS was associated with incomplete functional recovery at 1 month only (odds ratio=1.77, SE=0.37 p=0.007). No association was found between AMS and functional recovery in patients with no LOC. Neither LOC nor AMS was predictive of functional recovery at later times. CONCLUSIONS These findings highlight the need to include symptom-focused clinical variables that pertain to the injury itself when assessing who might be at highest risk of incomplete functional recovery post-mTBI.
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Affiliation(s)
- Durga Roy
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Matthew E Peters
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Allen D Everett
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Jeannie-Marie Sheppard Leoutsakos
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Haijuan Yan
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Vani Rao
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Kathleen T Bechtold
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Haris I Sair
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Tim Van Meter
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Hayley Falk
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Alexandra Vassila
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Anna Hall
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Uju Ofoche
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Freshta Akbari
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Constantine Lyketsos
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Frederick Korley
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
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9
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van der Mei WF, Barbano AC, Ratanatharathorn A, Bryant RA, Delahanty DL, deRoon-Cassini TA, Lai BS, Lowe SR, Matsuoka YJ, Olff M, Qi W, Schnyder U, Seedat S, Kessler RC, Koenen KC, Shalev AY. Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study. BMC Emerg Med 2020; 20:16. [PMID: 32122334 PMCID: PMC7053081 DOI: 10.1186/s12873-020-00308-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator. METHODS We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities. RESULTS Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided. CONCLUSION Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation. TRIAL REGISTRATION Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.
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Affiliation(s)
- Willem F. van der Mei
- Department of Population Health, New York University Langone Health, 227 E 30th St, New York, NY USA
| | - Anna C. Barbano
- Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY 10016 USA
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th St, New York, NY 10032 USA
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Douglas L. Delahanty
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, Kent, OH 44242 USA
| | - Terri A. deRoon-Cassini
- Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Betty S. Lai
- Department of Counselling, Developmental, and Educational Psychology, Lynch School of Education and Human Development, Boston College, Campion Hall Room 313, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA
| | - Sarah R. Lowe
- Department of Psychology, Montclair State University, 1 Normal Avenue, Montclair, NJ 07043 USA
| | - Yutaka J. Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chou-ku, Tokyo, 104-0045 Japan
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Postbus 240, 1110 AE Diemen, The Netherlands
| | - Wei Qi
- Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY 10016 USA
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, PO Box 1931, Lenggstrasse 31, 8032 Zürich, Switzerland
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602 South Africa
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Kresge 505, 677 Huntington Avenue, Kresge Building, Boston, MA 02115 USA
| | - Arieh Y. Shalev
- Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY 10016 USA
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10
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A Systematic Review and Meta-analysis on PTSD Following TBI Among Military/Veteran and Civilian Populations. J Head Trauma Rehabil 2020; 35:E21-E35. [DOI: 10.1097/htr.0000000000000514] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Subcortical shape and neuropsychological function among U.S. service members with mild traumatic brain injury. Brain Imaging Behav 2019; 13:377-388. [PMID: 29564659 DOI: 10.1007/s11682-018-9854-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In a recent manuscript, our group demonstrated shape differences in the thalamus, nucleus accumbens, and amygdala in a cohort of U.S. Service Members with mild traumatic brain injury (mTBI). Given the significant role these structures play in cognitive function, this study directly examined the relationship between shape metrics and neuropsychological performance. The imaging and neuropsychological data from 135 post-deployed United States Service Members from two groups (mTBI and orthopedic injured) were examined. Two shape features modeling local deformations in thickness (RD) and surface area (JD) were defined vertex-wise on parametric mesh-representations of 7 bilateral subcortical gray matter structures. Linear regression was used to model associations between subcortical morphometry and neuropsychological performance as a function of either TBI status or, among TBI patients, subjective reporting of initial concussion severity (CS). Results demonstrated several significant group-by-cognition relationships with shape metrics across multiple cognitive domains including processing speed, memory, and executive function. Higher processing speed was robustly associated with more dilation of caudate surface area among patients with mTBI who reported more than one CS variables (loss of consciousness (LOC), alteration of consciousness (AOC), and/or post-traumatic amnesia (PTA)). These significant patterns indicate the importance of subcortical structures in cognitive performance and support a growing functional neuroanatomical literature in TBI and other neurologic disorders. However, prospective research will be required before exact directional evolution and progression of shape can be understood and utilized in predicting or tracking cognitive outcomes in this patient population.
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12
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Roy D, Peters ME, Everett A, Leoutsakos JM, Yan H, Rao V, Bechtold K, Sair H, Van Meter TE, Falk H, Vassila A, Hall A, Ofoche U, Akbari F, Lyketsos CG, Korley F. Loss of consciousness and altered mental state predicting depressive and post-concussive symptoms after mild traumatic brain injury. Brain Inj 2019; 33:1064-1069. [DOI: 10.1080/02699052.2019.1606447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allen Everett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris Sair
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hayley Falk
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Anna Hall
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uju Ofoche
- Department of Forensic Science, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Freshta Akbari
- Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fredrick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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13
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Michopoulos V, Maples-Keller J, Roger EI, Beaudoin FL, Sumner JA, Rothbaum BO, Hudak L, Gillespie CF, Kronish IM, McLean SA, Ressler KJ. Nausea in the peri-traumatic period is associated with prospective risk for PTSD symptom development. Neuropsychopharmacology 2019; 44:668-673. [PMID: 30464257 PMCID: PMC6372625 DOI: 10.1038/s41386-018-0276-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/10/2018] [Indexed: 11/09/2022]
Abstract
While nausea often develops following exposure to trauma, little is known regarding the relationship between peri-traumatic nausea and prospective risk for developing posttraumatic stress disorder (PTSD). We examined the association between peri-traumatic nausea and PTSD symptom development in three independent cohorts. Participants were recruited from (1) the Emergency Departments (ED) at Grady Memorial Hospital (GMH) in Atlanta, GA, (2) from multiple other ED sites in the TRYUMPH Research Network, and (3) from the ED during evaluation for suspected acute coronary syndrome in the REACH cohort. Administration of IV ondansetron, the most predominant antiemetic used at GMH, was used as a surrogate marker for nausea in the initial GMH cohort; nausea was then directly assessed in the internal validation at GMH, and within the replication TRYUMPH Research Network and REACH cohorts. In the GMH cohort (N = 363), ondansetron administration was associated with increased 1- and 3-month posttrauma PTSD symptoms in adjusted models (all p's < 0.05). In the GMH internal validation, nausea significantly predicted 1 month (p = 0.009; n = 68) and 3 month (p = 0.029; n = 54) PTSD symptoms. In the TRYUMPH cohort (N = 1846), patient reported nausea in the ED was significantly associated with increased PTSD symptoms (p = 0.009) in adjusted models. In the REACH cohort (N = 758), peri-traumatic nausea was associated with PTSD symptom severity at the 1-month follow-up in adjusted models (p's ≤ 0.008). The current prospective data from three independent cohorts suggest that peri-traumatic nausea is a prospective predictor of PTSD symptom development. Further studies are needed to determine the mechanistic role of nausea as an intermediate phenotype of PTSD risk.
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Affiliation(s)
- Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. .,Yerkes National Primate Research Center, Atlanta, GA, USA.
| | - Jessica Maples-Keller
- 0000 0001 0941 6502grid.189967.8Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Elizabeth I. Roger
- 0000 0001 0941 6502grid.189967.8Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA ,0000 0001 0639 7318grid.415879.6Naval Medical Center San Diego, San Diego, CA USA
| | - Francesca L. Beaudoin
- 0000 0004 1936 9094grid.40263.33Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI USA
| | - Jennifer A. Sumner
- 0000 0001 2285 2675grid.239585.0Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY USA
| | - Barbara O. Rothbaum
- 0000 0001 0941 6502grid.189967.8Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Lauren Hudak
- 0000 0001 0941 6502grid.189967.8Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Charles F. Gillespie
- 0000 0001 0941 6502grid.189967.8Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Ian M. Kronish
- 0000 0001 2285 2675grid.239585.0Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY USA
| | - Samuel A. McLean
- 0000 0001 1034 1720grid.410711.2Departments of Anesthesiology and Emergency Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Kerry J. Ressler
- 0000 0001 0941 6502grid.189967.8Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA ,000000041936754Xgrid.38142.3cMclean Hospital, Harvard Medical School, Belmont, MA USA
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14
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Fekadu W, Mekonen T, Belete H, Belete A, Yohannes K. Incidence of Post-Traumatic Stress Disorder After Road Traffic Accident. Front Psychiatry 2019; 10:519. [PMID: 31379631 PMCID: PMC6659351 DOI: 10.3389/fpsyt.2019.00519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) occurs after exposure to actual or threatened death, serious injury, or sexual violence. Road traffic accident (RTA) is one of the traumatic experiences, which may result in PTSD. But treatment is mainly concentrated on physical health. This may be due to a lack of evidence in low-income countries. Aim: To determine the incidence level and identify risk factors of PTSD after RTA. Methods: Longitudinal panel study was done to assess the incidence of PTSD after RTA. The study was conducted in three orthopedic settings of Bahir Dar town Northwest, Ethiopia. The study was on 299 adult car accident survivors. PTSD Checklist (PCL) civilian version, Sheehan disability assessment scale, Patient Health Question (PHQ-2), and Alcohol Use Disorder Identification Test (AUDIT) were instruments to assess the outcome and associated factors. The generalized linear model with Poisson log-linear method was applied to identify associated factors. Ethical clearance was obtained from Bahir Dar University. Individuals with PTSD symptoms were linked to the psychiatric clinic. Result: One hundred thirty-nine (46.5%) participants had at least three extremely severe symptoms that fulfil criteria B, C, and D of Diagnostic Statistical Manual IV of PTSD. The most frequent severe symptoms were having repeated, disturbing memories, thoughts, or images. Two hundred ten (70.2%) participants reported the extreme impact of the accident on work or schooling and 156 (51.9%) reported extreme problems in social functioning. Alcohol dependence, hazardous alcohol consumption, and harmful use were reported by 7.9%, 15.1%, and 4.7% of the participants, respectively. In the final model witnessing death, severe sleep problem and severe impairment in family functioning were significantly associated with PTSD. Conclusion: Nearly half of RTA survivors develop PTSD. Clinicians need to link these patients to the psychiatry clinic. Special attention should be given to patients who witnessed death, with a serious disability, and previous psychiatric history.
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Affiliation(s)
- Wubalem Fekadu
- Psychiatry Department, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Psychiatry Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfa Mekonen
- Psychiatry Department, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habte Belete
- Psychiatry Department, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amsalu Belete
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Dilla, Ethiopia
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15
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Abstract
BACKGROUND The psychological response of injured people after traffic accidents includes stress and depression. PURPOSE To assess orthopaedic patients' stress, depression, and satisfaction with life after traffic accidents in Greece. METHODS Descriptive, longitudinal, correlational study. Patients' background factors, injury severity, scores on the Impact of Events Scale-Revised (IES-R), the Center for Epidemiologic Studies Depression (CES-D) Scale, and the Satisfaction With Life Quality (SWLQ) Scale were recorded. The principles of the Declaration of Helsinki were applied. RESULTS In total, 60 patients participated in this study during hospitalization following a road traffic accident and 40 patients at 6 months after. Participants were mostly men (75%) with severe injuries (50%). The IES-R score at 6 months was significantly lower than during hospitalization. One out of 3 people had a CES-D score, which is considered of clinical significance. The SWLQ scores were considered high. CONCLUSION As posttraumatic stress and depression seem to affect a considerable percentage of people involved in road traffic accidents in Greece, these individuals should be assessed for posttraumatic stress and depression while still hospitalized.
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16
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Nathan DE, Bellgowan JAF, French LM, Wolf J, Oakes TR, Mielke J, Sham EB, Liu W, Riedy G. Assessing the Impact of Post-Traumatic Stress Symptoms on the Resting-State Default Mode Network in a Military Chronic Mild Traumatic Brain Injury Sample. Brain Connect 2017; 7:236-249. [DOI: 10.1089/brain.2016.0433] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Dominic E. Nathan
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
- North Tide LLC, Dulles, Virginia
- Uniformed Services University, Bethesda, Maryland
| | - Julie A. Frost Bellgowan
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
- North Tide LLC, Dulles, Virginia
| | - Louis M. French
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
- Center of Neuroscience and Regenerative Medicine (CNRM), Bethesda, Maryland
| | - Jonathan Wolf
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Terrence R. Oakes
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jeannine Mielke
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Elyssa B. Sham
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
- North Tide LLC, Dulles, Virginia
| | - Wei Liu
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
- North Tide LLC, Dulles, Virginia
| | - Gerard Riedy
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University, Bethesda, Maryland
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17
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Stebnicki MA, Clemmons-James D, Leierer S. A Survey of Military Counseling Content and Curriculum Among Council on Rehabilitation Education- and Council for Accreditation of Counseling and Related Educational Programs-Accredited Programs. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2017. [DOI: 10.1891/2168-6653.31.1.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose:To determine the amount, frequency, and type of course content related to military counseling issues in Council on Rehabilitation Education (CORE)- and Council for Accreditation of Counseling and Related Educational Programs (CACREP)-accredited master’s-level counselor education programs.Methods:A questionnaire was sent to all CORE- and CACREP-accredited program directors/coordinators (N= 383) via Microsoft Outlook e-mail system. The authors used the 6-item questionnaire to ask participants to report data in the following areas: (a) if their program offered a certificate program, specialty track, concentration, or degree program in military counseling; (b) if not, do they intend to add a stand-alone military counseling course, certificate program, specialty track, or degree program in military counseling; (c) if they currently have plans, how do they intend to deliver such topics within the structure of their curriculum or counselor education program; (d) if coursework already exists, how is it currently structured within their curriculum and counselor education program; and (e) 3 open-end questions requesting course titles; semester hours related to course content, curriculum, and/or concentration, and comments regarding student assignments and/or projects that are military related.Results:Overall, out of 362 programs surveyed, 85 (23.4%) responded. All 85 of survey respondents indicated that they did not have a (a) certificate program, (b) specialty track, or (c) degree program that related to military counseling. Of the 85 programs, 34 schools (4.7%) had developed stand-alone courses that offered military counseling content. More than two-thirds of the 85 programs reported covering military counseling content in various courses across the curriculum.Conclusion:None of the program directors/coordinators in this study indicated they had a specialty track, concentration, or certificate program. Some of the participants indicated they were considering adding additional seminars, courses, and other student experiences that would integrate assessment, diagnosis, and treatment for persons that are active-duty personnel and veterans. Overall, the data suggest that there is greater attention and a willingness among counselor educators to infuse military counseling–related coursework. This is promising because it is critical that preprofessionals and professionals alike be introduced to the emerging population of providing rehabilitation counseling services to military personnel, veterans, and their family members.
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Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2016; 33:1969-1994. [PMID: 26729611 DOI: 10.1089/neu.2015.4252] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review examined pre- and post-injury prevalence of, and risk factors for, anxiety disorders and depressive disorders after traumatic brain injury (TBI), based on evidence from structured diagnostic interviews. A systematic literature search was conducted in EMBASE, MEDLINE, Cochrane Central, PubMed, PsycINFO, and Google Scholar. We identified studies in civilian adults with TBI reporting on the prevalence of anxiety and depressive disorders using structured diagnostic interviews and assessed their quality. Pooled pre- and post-injury prevalence estimates of anxiety disorders and depressive disorders were computed. A total of 34 studies described in 68 publications were identified, often assessing anxiety disorders (n = 9), depressive disorders (n = 7), or a combination of disorders (n = 6). Prevalence rates of psychiatric disorders varied widely. Pooled prevalence estimates of anxiety and depressive disorders were 19% and 13% before TBI and 21% and 17% in the first year after TBI. Pooled prevalence estimates increased over time and indicated high long-term prevalence of Axis I disorders (54%), including anxiety disorders (36%) or depressive disorders (43%). Females, those without employment, and those with a psychiatric history before TBI were at higher risk for anxiety and depressive disorders after TBI. We conclude that a substantial number of patients encounter anxiety and depressive disorders after TBI, and that these problems persist over time. All health care settings should pay attention to the occurrence of psychiatric symptoms in the aftermath of TBI to enable early identification and treatment of these disorders and to enhance the recovery and quality of life of TBI survivors.
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Affiliation(s)
- Annemieke C Scholten
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Juanita A Haagsma
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Maryse C Cnossen
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Miranda Olff
- 2 Department of Psychiatry, Center for Psychological Trauma, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Ed F van Beeck
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Suzanne Polinder
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
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Popescu M, Hughes JD, Popescu EA, Riedy G, DeGraba TJ. Reduced prefrontal MEG alpha-band power in mild traumatic brain injury with associated posttraumatic stress disorder symptoms. Clin Neurophysiol 2016; 127:3075-3085. [PMID: 27472543 DOI: 10.1016/j.clinph.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine if changes in cortical alpha-band power in patients with mild traumatic brain injury (mTBI) are associated with the severity of their post-traumatic stress disorder (PTSD) symptoms, and if injury severity and level of exposure to psychologically traumatic events are predictors of these electrophysiological changes. METHODS Resting-state magnetoencephalographic recordings were analyzed in 32 patients with mTBI. Alpha-band power was estimated for each patient in 68 cortical regions and was compared between groups of patients with low versus high PTSD symptoms severity. RESULTS Participants with high PTSD symptom severity showed reduced alpha-band power bilaterally in the superior and middle frontal gyri and frontal poles, and in the left inferior frontal gyrus. Alpha-band power in bilateral middle frontal gyri and frontal poles was negatively correlated with scores reflecting symptoms of emotional numbing. Loss of consciousness (LOC) associated with mTBI and level of exposure to psychologically traumatic events were predictors of decreased prefrontal alpha-band power in some of these regions. CONCLUSION Altered prefrontal alpha-band activity, shown to be partly explained by mTBI-related LOC, is associated with PTSD symptoms severity. SIGNIFICANCE Our findings will guide future studies addressing the electrophysiological mechanisms underlying a higher incidence of PTSD in patients with mTBI.
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Affiliation(s)
- Mihai Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John D Hughes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of NeuroTrauma, Naval Medical Research Center, Silver Spring, MD, USA.
| | - Elena-Anda Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gerard Riedy
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas J DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Hu H, Zhou Y, Wang Q, Su S, Qiu Y, Ge J, Wang Z, Xiao Z. Association of abnormal white matter integrity in the acute phase of motor vehicle accidents with post-traumatic stress disorder. J Affect Disord 2016; 190:714-722. [PMID: 26600413 DOI: 10.1016/j.jad.2015.09.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/08/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A small portion of the Motor vehicle accidents (MVA) survivors would develop post-traumatic stress disorder (PTSD), which would cause substantial social function loss. How to identify those high-risk MVA survivors in the acute phase of the trauma is the first step to prevent the onset of PTSD. In the present study, we studied white matter integrity of subjects post to MVA by diffusional tensor imaging (DTI). METHODS To investigate whether the integrity of the white matter was impaired in the acute phase of the MVA among survivors who later develop PTSD and whether it could predict the severity of PTSD while being diagnosed. MVA Survivors were recruited to get trauma-specific clinical assessments and received DTI scan within 2 days from the MVA. These survivors were divided into 2 groups, PTSD group and trauma control (TC) group based on the clinical follow-up interview. Tract-Based Spatial Statistics (TBSS) was carried out to investigate difference in white matter integrity between 2 groups within DTI parameter maps. White matter integrity was measured by using fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radical diffusivity (RD). RESULTS Compared with TC group, PTSD group showed lower FA value in multiple regions of both hemispheres, mainly involving anterior thalamic radiation, cortico-spinal tract, forceps minor, uncinate, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, cingulum and superior longitudinal fasciculus. Increased RD was also detected in PTSD group in the posterior part of right hemisphere, involving forceps major, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, cingulum, hippocampus and superior longitudinal fasciculus. The baseline FA and RD values correlated with Clinician-Administered PTSD Scale scores at clinical follow up. CONCLUSION MVA survivors who later developed PTSD had more abnormalities in white matter integrity in the acute phase than those non-PTSD MVA survivors. Imaging markers of white matter integrity might be helpful in early identification of MVA survivors at high risk of PTSD. LIMITATIONS Larger sample size in our extensive study is needed to confer a robust inference and image data at follow up are needed to observe the longitudinal changes of white matter integrity.
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Affiliation(s)
- Hao Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Qian Wang
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, PR China
| | - Shanshan Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China
| | - Yongming Qiu
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Jianwei Ge
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China.
| | - Zeping Xiao
- Shanghai Jiao Tong University School of Medicine, PR China.
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Huang M, Risling M, Baker DG. The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury. Psychoneuroendocrinology 2016; 63:398-409. [PMID: 25769625 DOI: 10.1016/j.psyneuen.2015.02.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 02/13/2015] [Accepted: 02/15/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pervasive use of improvised explosive devices (IEDs), rocket-propelled grenades, and land mines in the recent conflicts in Iraq and Afghanistan has brought traumatic brain injury (TBI) and its impact on health outcomes into public awareness. Blast injuries have been deemed signature wounds of these wars. War-related TBI is not new, having become prevalent during WWI and remaining medically relevant in WWII and beyond. Medicine's past attempts to accurately diagnose and disentangle the pathophysiology of war-related TBI parallels current lines of inquiry and highlights limitations in methodology and attribution of symptom etiology, be it organic, psychological, or behavioral. New approaches and biomarkers are needed. PRECLINICAL Serological biomarkers and biomarkers of injury obtained with imaging techniques represent cornerstones in the translation between experimental data and clinical observations. Experimental models for blast related TBI and PTSD can generate critical data on injury threshold, for example for white matter injury from acceleration. Carefully verified and validated models can be evaluated with gene expression arrays and proteomics to identify new candidates for serological biomarkers. Such models can also be analyzed with diffusion MRI and microscopy in order to identify criteria for detection of diffuse white matter injuries, such as DAI (diffuse axonal injury). The experimental models can also be analyzed with focus on injury outcome in brain stem regions, such as locus coeruleus or nucleus raphe magnus that can be involved in response to anxiety changes. CLINICAL Mild (and some moderate) TBI can be difficult to diagnose because the injuries are often not detectable on conventional MRI or CT. There is accumulating evidence that injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (ALFMA, peaked at 1-4Hz) that can be measured and localized by magnetoencephalography (MEG). MEG imaging detects TBI abnormalities at the rates of 87% for the mild TBI, group (blast-induced plus non-blast causes) and 100% for the moderate group. Among the mild TBI patients, the rates of abnormalities are 96% and 77% for the blast and non-blast TBI groups, respectively. There is emerging evidence based on fMRI and MEG studies showing hyper-activity in the amygdala and hypo-activity in pre-frontal cortex in individuals with PTSD. MEG signal may serve as a sensitive imaging marker for mTBI, distinguishable from abnormalities generated in association with PTSD. More work is needed to fully describe physiological mechanisms of post-concussive symptoms.
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Affiliation(s)
- Mingxiong Huang
- Radiology Services, VA San Diego Healthcare System, San Diego, CA, USA; Research Services, VA San Diego Healthcare System, San Diego, CA, USA; Department of Radiology, University of California, San Diego, CA, USA.
| | - Mårten Risling
- Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden
| | - Dewleen G Baker
- Veterans Affairs Center for Excellence in Stress and Mental Health (CESAMH), San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, USA
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Alway Y, McKay A, Gould KR, Johnston L, Ponsford J. FACTORS ASSOCIATED WITH POSTTRAUMATIC STRESS DISORDER FOLLOWING MODERATE TO SEVERE TRAUMATIC BRAIN INJURY: A PROSPECTIVE STUDY. Depress Anxiety 2016. [PMID: 26219232 DOI: 10.1002/da.22396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study prospectively examined the relationship between preinjury, injury-related, and postinjury factors and posttraumatic stress disorder (PTSD) following moderate to severe traumatic brain injury (TBI). METHOD Two hundred and three participants were recruited during inpatient admission following moderate to severe TBI. Participants completed an initial assessment soon after injury and were reassessed at 3, 6, and 12 months, 2, 3, 4, and 5 years postinjury. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-fourth edition was used to diagnose pre- and postinjury PTSD and other psychiatric disorders. The Glasgow Outcome Scale-Extended (GOSE) and the Quality of Life Inventory (QOLI) were used to evaluate functional and psychosocial outcome from 6 months postinjury. RESULTS The frequency of PTSD ranged between 0.5 and 9.4% during the 5-year period, increasing throughout the first 12 months and declining thereafter. After controlling for other predictors, shorter posttraumatic amnesia duration (odds ratio = 0.96, 95% CI = 0.92-1.00), other concurrent psychiatric disorder (odds ratio = 14.22, 95% CI = 2.68-75.38), and lower GOSE (odds ratio = 0.38, 95% CI = 0.20-0.72) and QOLI scores (odds ratio = 0.97, 95% CI = 0.95-0.97) were associated with greater odds of having injury-related PTSD. DISCUSSION The results of this study indicate that while shorter posttraumatic amnesia duration is associated with PTSD, greater TBI severity does not prevent PTSD from evolving. Patients with PTSD experienced high rates of psychiatric comorbidity and poorer functional and quality of life outcomes after TBI. CONCLUSION There is a need to direct clinical attention to early identification and treatment of PTSD following TBI to improve outcomes.
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Affiliation(s)
- Yvette Alway
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Kate Rachel Gould
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.,National Trauma Research Institute, Melbourne, Australia
| | - Lisa Johnston
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.,National Trauma Research Institute, Melbourne, Australia
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Stein MB, Kessler RC, Heeringa SG, Jain S, Campbell-Sills L, Colpe LJ, Fullerton CS, Nock MK, Sampson NA, Schoenbaum M, Sun X, Thomas ML, Ursano RJ. Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Am J Psychiatry 2015; 172:1101-11. [PMID: 26337036 PMCID: PMC5125442 DOI: 10.1176/appi.ajp.2015.14121572] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel. METHOD A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1-2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms. RESULTS Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance. CONCLUSIONS The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.
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Acheson DT, Geyer MA, Risbrough VB. Psychophysiology in the study of psychological trauma: where are we now and where do we need to be? Curr Top Behav Neurosci 2014; 21:157-183. [PMID: 25158622 DOI: 10.1007/7854_2014_346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a major public health concern, which has been seeing increased recent attention partly due to the wars in Iraq and Afghanistan. Historically, research attempting to understand the etiology and treatment of PTSD has made frequent use of psychophysiological measures of arousal as they provide a number of advantages in providing objective, non-self-report outcomes that are closely related to proposed neurobiological mechanisms and provide opportunity for cross-species translation. Further, the ongoing shift in classification of psychiatric illness based on symptom clusters to specific biological, physiological, and behavioral constructs, as outlined in the US National Institute of Mental Health (NIMH) Research Domain Criteria project (RDoC), promises that psychophysiological research will continue to play a prominent role in research on trauma-related illnesses. This review focuses on the current state of the knowledge regarding psychophysiological measures and PTSD with a focus on physiological markers associated with current PTSD symptoms, as well as markers of constructs thought to be relevant to PTSD symptomatology (safety signal learning, fear extinction), and psychophysiological markers of risk for developing PTSD following trauma. Future directions and issues for the psychophysiological study of trauma including traumatic brain injury (TBI), treatment outcome studies, and new wearable physiological monitoring technologies are also discussed.
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Affiliation(s)
- D T Acheson
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. Mail Code 0804, La Jolla, CA, 92093-0804, USA
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