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McGinnis CB, Wang F, Chiappelli AL, Okonkwo DO, Darby JM. Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal Syndrome. J Pharm Pract 2024; 37:665-670. [PMID: 36961745 DOI: 10.1177/08971900231167932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Background: Anticonvulsant prophylaxis (ACP) for early post-traumatic seizures (PTS) is recommended in patients with traumatic brain injury (TBI). Phenobarbital (PB) may be used to prevent alcohol withdrawal syndrome (AWS) in at-risk patients. The dual-purpose use of PB in the TBI population would allow for consolidation of pharmacotherapy. Objective: The primary objective of this study was to determine the frequency of early PTS in TBI patients at risk of AWS treated with PB as ACP. Secondary objectives included determining rates of over sedation and endotracheal intubation. Methods: Patients received an intravenous (IV) loading dose of PB at 15-20 mg/kg followed by 1 mg/kg every 12 hours for 7 days with a goal level of 15-20 mcg/mL. Medication data, seizure frequency, and episodes of over sedation and endotracheal intubation were collected. Results: Eighty patients were treated with PB over a 1-year period. Thirty-nine patients were analyzed. Median loading dose was 19.9 (Interquartile Range 19.1-20.0) mg/kg with a median post load level of 21.7 mcg/mL (IQR 18.3-25.8) mcg/mL. One patient (2.6%) had electrographic evidence for early PTS. PB was discontinued in 4 (10.3%) patients out of concern for over sedation. One patient required endotracheal intubation after rapid PB loading. Conclusion: The frequency of early PTS was low when PB was used as primary ACP in patients with TBI at risk for AWS. Over sedation is a potential adverse effect that should be considered in the choice of ACP. No conclusions can be drawn as to the effectiveness of PB in preventing AWS.
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Affiliation(s)
- Cory B McGinnis
- Department of Pharmacy, UPMC Presbyterian, Pittsburgh, PA, USA
| | - Fajun Wang
- Department of Critical Care Medicine, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - David O Okonkwo
- Department of Neurological Surgery, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph M Darby
- Department of Critical Care Medicine, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Neurological Surgery, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Surgery, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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2
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Lang B, Kerr ZY, Chandran A, Walton SR, Mannix R, Lempke LB, DeFreese JD, Echemendia RJ, Guskiewicz KM, Meehan III WP, McCrea MA, Brett BL. The Longitudinal Relationship Between Concussion History, Years of American Football Participation, and Alcohol Use Among Former National Football League Players: an NFL-LONG Study. Arch Clin Neuropsychol 2024; 39:221-226. [PMID: 37609946 PMCID: PMC10879921 DOI: 10.1093/arclin/acad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Investigate the relationships between concussion history and years of football participation (repetitive head impact proxy) with alcohol use across multiple decades in former professional football players. METHODS Participants (n = 348; mean age = 49.0 ± 9.4) completed health questionnaires in 2001 and 2019, which included self-reported concussion history and years of participation. Alcohol use frequency and amount per occasion were reported for three timepoints: during professional career, 2001, and 2019. Ordinal logistic regression models were fit to test associations of concussion history and years of participation with alcohol use at each timepoint. RESULTS There were no significant associations between either concussion history or years of football participation with alcohol use (frequency and amount per occasion) at any timepoint. Effect estimates for concussion history and years of football participation with alcohol use were generally comparable across timepoints. CONCLUSIONS Later life alcohol use by former American football players is not associated with concussion history or years of exposure to football.
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Affiliation(s)
- Brittany Lang
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, United States
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN 46220, United States
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA 23284, United States
| | - Rebekah Mannix
- Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Landon B Lempke
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, United States
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc., State College, PA 16801, United States
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, United States
| | - William P Meehan III
- Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA 02115, United States
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
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Arango-Lasprilla JC, Watson JD, Rodríguez MJ, Ramos-Usuga D, Perrin PB. Patterns of Alcohol Use in Hispanic Individuals with TBI over the Ten Years Post-Injury: A Model Systems Study. J Pers Med 2024; 14:105. [PMID: 38248806 PMCID: PMC10817313 DOI: 10.3390/jpm14010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
The study's aim was to examine alcohol consumption patterns and predictors of consumption across time among Hispanics with traumatic brain injury (TBI) in the U.S. within ten years post-injury. This longitudinal cohort study included 1342 Hispanic individuals (77.6% males) from the multi-site, longitudinal TBI Model Systems (TBIMS) database. The main outcome measures were consumption information, demographic, and injury characteristics. Across the full sample, alcohol consumption variables generally demonstrated quadratic movement characterized by an initial increase followed by a plateau or slight decrease over the ten years post-injury. The predictors of higher consumption were being men, single, with a history of excessive alcohol use, with a nonviolent mechanism of injury, shorter duration of PTA, and higher levels of education. Participants had a greater number of 5+ drinks/episode occurrences in the past month if they were men and had had a greater number of 5+ drinks/episode occurrences in the month before injury. There was no differential change in alcohol consumption over time as a function of these predictors. This study identified a profile of at-risk Hispanics with TBI for increased alcohol consumption. These individuals should be identified and targeted for early evidence-based alcohol intervention after TBI when results might be most favorable.
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Affiliation(s)
| | - Jack D. Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Miriam J. Rodríguez
- School of Public Health, Department of Health and Wellness Design, Indiana University, Bloomington, IN 47408, USA;
| | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain;
| | - Paul B. Perrin
- School of Data Science, Department of Psychology, University of Virginia, Charlottesville, VA 22904, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
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Li LM, Carson A, Dams-O'Connor K. Psychiatric sequelae of traumatic brain injury - future directions in research. Nat Rev Neurol 2023; 19:556-571. [PMID: 37591931 DOI: 10.1038/s41582-023-00853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person's sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.
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Affiliation(s)
- Lucia M Li
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Deshetty UM, Periyasamy P. Potential Biomarkers in Experimental Animal Models for Traumatic Brain Injury. J Clin Med 2023; 12:3923. [PMID: 37373618 DOI: 10.3390/jcm12123923] [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: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Traumatic brain injury (TBI) is a complex and multifaceted disorder that has become a significant public health concern worldwide due to its contribution to mortality and morbidity. This condition encompasses a spectrum of injuries, including axonal damage, contusions, edema, and hemorrhage. Unfortunately, specific effective therapeutic interventions to improve patient outcomes following TBI are currently lacking. Various experimental animal models have been developed to mimic TBI and evaluate potential therapeutic agents to address this issue. These models are designed to recapitulate different biomarkers and mechanisms involved in TBI. However, due to the heterogeneous nature of clinical TBI, no single experimental animal model can effectively mimic all aspects of human TBI. Accurate emulation of clinical TBI mechanisms is also tricky due to ethical considerations. Therefore, the continued study of TBI mechanisms and biomarkers, of the duration and severity of brain injury, treatment strategies, and animal model optimization is necessary. This review focuses on the pathophysiology of TBI, available experimental TBI animal models, and the range of biomarkers and detection methods for TBI. Overall, this review highlights the need for further research to improve patient outcomes and reduce the global burden of TBI.
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Affiliation(s)
- Uma Maheswari Deshetty
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Palsamy Periyasamy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Synergistic effect of mild traumatic brain injury and alcohol aggravates neuroinflammation, amyloidogenesis, tau pathology, neurodegeneration, and blood-brain barrier alterations: Impact on psychological stress. Exp Neurol 2022; 358:114222. [PMID: 36089059 DOI: 10.1016/j.expneurol.2022.114222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/12/2022] [Accepted: 09/03/2022] [Indexed: 11/24/2022]
Abstract
After a mild traumatic brain injury (mTBI), victims often experience emotional/psychological stress such as heightened irritability, anxiety, apathy, and depression. Severe mental health complications are common in military populations following a combat-acquired TBI and intensified unhealthy alcohol use. The high prevalence of alcohol abuse among TBI victims underscores how alcohol abuse exacerbates emotional/psychological symptoms such as depression and anxiety. The experimental mTBI was induced in vivo by fluid percussion injury (15 psi) in mice and ethanol diet feeding continued for 28 days. We analyzed different biomarkers of the biochemical mechanisms and pathophysiology of neurological damage, and functional outcome of psychological stress by sucrose preference, and light-dark tests. We demonstrated that the synergistic effect of TBI and alcohol leads to psychological stress such as depression and anxiety. The studies showed that oxidative stress, amyloidogenesis, tau pathology, neuroinflammation, and neurodegeneration markers were elevated, and glial activation and blood-brain barrier (BBB) damage were exacerbated during the synergistic effect of TBI and alcohol. Further, we studied the biochemical mechanisms of psychological stress that showed the significant reduction of 5-HT1AR, neuropeptide-Y, and norepinephrine, and an increase in monoamine oxidase-a in the combined effect of TBI and alcohol. This work suggested that the combined TBI and alcohol-induced effect leads to depression and anxiety, via sequential biochemical changes that cause neuroinflammation, amyloidogenesis, tau pathology, neurodegeneration, and BBB alterations. This clinically relevant study will contribute to developing a comprehensive therapeutic approach for patients suffering from TBI and alcohol-mediated neurological damage and psychological stress.
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Svedung Wettervik T, Enblad P, Lewén A. Pre-injury chronic alcohol abuse predicts intracranial hemorrhagic progression, unfavorable clinical outcome, and mortality in severe traumatic brain injury. Brain Inj 2021; 35:1569-1576. [PMID: 34543084 DOI: 10.1080/02699052.2021.1975196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to determine the incidence of pre-injury alcohol abuse in TBI at our neurointensive care unit (NICU), the relation to intracranial hemorrhage evolution, and clinical outcome. METHODS Patients with TBI treated at our NICU at Uppsala university hospital, Sweden, 2008-2018, were included. Clinical, radiological, and outcome variables were evaluated. RESULTS Of 844 patients with TBI, 147 (17%) had a history of pre-injury alcohol abuse and these patients were slightly older, but had a similar Charlson co-morbidity index as the other patients. They were more often injured by falls and more frequently developed acute subdural hematomas and cerebral contusions. Their platelets were lower and their IVY bleeding time slightly longer. Patients with pre-injury alcohol abuse more often exhibited an intracranial hemorrhage progression on the second computed tomography. Pre-injury alcohol abuse was an independent predictor of increased mortality (odds ratio = 2.96, p-value = 0.001) and decreased favorable outcome (odds ratio = 0.46, p-value = 0.001) in multiple regression analyses. CONCLUSIONS Pre-injury alcohol abuse was common in severe TBI, associated with coagulopathy, worse intracranial hemorrhage/injury evolution, and independently predicted poor clinical outcome. These patients deserve more attention in care and research to address specific challenges including disturbed hemostasis.
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Affiliation(s)
| | - Per Enblad
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Anders Lewén
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
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8
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Incidence of New Neuropsychiatric Disorder Diagnoses Following Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E352-E360. [PMID: 31996603 DOI: 10.1097/htr.0000000000000551] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neuropsychiatric disturbances (NPDs) are common following traumatic brain injury (TBI) and associated with poor recovery. Prior estimates of NPD following TBI failed to account for preexisting NPDs or potential confounding. METHODS We estimated the risk of anxiety, posttraumatic stress disorder (PTSD), bipolar disorder, and alcohol and substance dependence disorder diagnoses associated with TBI using administrative claims data from a large insurer in the United States, 2008-2014. We calculated rates of new NPD diagnoses during the 12 months before and 24 months after TBI and estimated the risk of NPD following TBI using a difference-in-difference approach and adjusting for confounders. RESULTS Before the TBI occurred, rates of NPD diagnoses were more than double in the TBI cohort (n = 207 354) relative to the no-TBI cohort (n = 414 708). TBI was associated with an increased risk of anxiety (rate ratio [RtR] = 1.08; 95% confidence interval [CI], 1.05-1.12) and PTSD (RtR = 1.41; 95% CI, 1.24-1.60) diagnoses. Rates of alcohol (RtR = 0.32; 95% CI, 0.30-0.34) and substance use disorder (RtR = 0.57; 95% CI, 0.55-0.59) diagnoses decreased following TBI. CONCLUSIONS In this large national study, rates of NPD were much higher among individuals with TBI than those in a non-TBI cohort, even before the TBI took place. TBI was associated with an increased risk of anxiety and PTSD diagnoses. Results from this study also suggest that individuals who sustain TBI have increased contact with the healthcare system during the months prior to injury, providing a window for intervention, especially for individuals diagnosed with alcohol dependence disorder.
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9
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Roberson SW, Patel MB, Dabrowski W, Ely EW, Pakulski C, Kotfis K. Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice. Curr Neuropharmacol 2021; 19:1519-1544. [PMID: 33463474 PMCID: PMC8762177 DOI: 10.2174/1570159x19666210119153839] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/12/2020] [Accepted: 01/13/2021] [Indexed: 11/22/2022] Open
Abstract
Traumatic brain injury (TBI) can initiate a very complex disease of the central nervous system (CNS), starting with the primary pathology of the inciting trauma and subsequent inflammatory and CNS tissue response. Delirium has long been regarded as an almost inevitable consequence of moderate to severe TBI, but more recently has been recognized as an organ dysfunction syndrome with potentially mitigating interventions. The diagnosis of delirium is independently associated with prolonged hospitalization, increased mortality and worse cognitive outcome across critically ill populations. Investigation of the unique problems and management challenges of TBI patients is needed to reduce the burden of delirium in this population. In this narrative review, possible etiologic mechanisms behind post-traumatic delirium are discussed, including primary injury to structures mediating arousal and attention and secondary injury due to progressive inflammatory destruction of the brain parenchyma. Other potential etiologic contributors include dysregulation of neurotransmission due to intravenous sedatives, seizures, organ failure, sleep cycle disruption or other delirium risk factors. Delirium screening can be accomplished in TBI patients and the presence of delirium portends worse outcomes. There is evidence that multi-component care bundles including an analgesia-prioritized sedation algorithm, regular spontaneous awakening and breathing trials, protocolized delirium assessment, early mobility and family engagement can reduce the burden of ICU delirium. The aim of this review is to summarize the approach to delirium in TBI patients with an emphasis on pathogenesis and management. Emerging CNS-active drug therapies that show promise in preclinical studies are highlighted.
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Affiliation(s)
| | | | | | | | | | - Katarzyna Kotfis
- Address correspondence to this author at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland; E-mail:
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10
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Hoffman J, Yu J, Kirstein C, Kindy MS. Combined Effects of Repetitive Mild Traumatic Brain Injury and Alcohol Drinking on the Neuroinflammatory Cytokine Response and Cognitive Behavioral Outcomes. Brain Sci 2020; 10:brainsci10110876. [PMID: 33228251 PMCID: PMC7699568 DOI: 10.3390/brainsci10110876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
The relationship between alcohol consumption and traumatic brain injury (TBI) often focuses on alcohol consumption increasing the likelihood of incurring a TBI, rather than alcohol use outcomes after TBI. However, patients without a history of an alcohol use disorder can also show increased problem drinking after single or multiple TBIs. Alcohol and mild TBI share diffuse deleterious neurological impacts and cognitive impairments; therefore, the purpose of these studies was to determine if an interaction on brain and behavior outcomes occurs when alcohol is consumed longitudinally after TBI. To examine the impact of mild repetitive TBI (rmTBI) on voluntary alcohol consumption, mice were subjected to four mild TBI or sham procedures over a 2 week period, then offered alcohol (20% v/v) for 2 weeks using the two-bottle choice, drinking in the dark protocol. Following the drinking period, mice were evaluated for neuroinflammatory cytokine response or tested for cognitive and behavioral deficits. Results indicate no difference in alcohol consumption or preference following rmTBI as compared to sham; however, increases in the neuroinflammatory cytokine response due to alcohol consumption and some mild cognitive behavioral deficits after rmTBI and alcohol consumption were observed. These data suggest that the cytokine response to alcohol drinking and rmTBI + alcohol drinking is not necessarily aggregate, but the combination does result in an exacerbation of cognitive behavioral outcomes.
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Affiliation(s)
- Jessica Hoffman
- Department of Psychiatry, Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence: (J.H.); (M.S.K.); Tel.: +1-919-843-4389 (J.H.)
| | - Jin Yu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL 33612, USA;
| | - Cheryl Kirstein
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL 33612, USA;
| | - Mark S. Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL 33612, USA;
- James A. Haley VA Medical Center, Tampa, FL 33612, USA
- Shriners Hospital for Children, Tampa, FL 33612, USA
- Correspondence: (J.H.); (M.S.K.); Tel.: +1-919-843-4389 (J.H.)
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11
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Sanchez CM, Titus DJ, Wilson NM, Freund JE, Atkins CM. Early Life Stress Exacerbates Outcome after Traumatic Brain Injury. J Neurotrauma 2020; 38:555-565. [PMID: 32862765 DOI: 10.1089/neu.2020.7267] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The neurocognitive impairments associated with mild traumatic brain injury (TBI) often resolve within 1-2 weeks; however, a subset of people exhibit persistent cognitive dysfunction for weeks to months after injury. The factors that contribute to these persistent deficits are unknown. One potential risk factor for worsened outcome after TBI is a history of stress experienced by a person early in life. Early life stress (ELS) includes maltreatment such as neglect, and interferes with the normal construction of cortical and hippocampal circuits. We hypothesized that a history of ELS contributes to persistent learning and memory dysfunction following a TBI. To explore this interaction, we modeled ELS by separating Sprague Dawley pups from their nursing mothers from post-natal days 2-14 for 3 h daily. At 2 months of age, male rats received sham surgery or mild to moderate parasagittal fluid-percussion brain injury. We found that the combination of ELS with TBI in adulthood impaired hippocampal-dependent learning, as assessed with contextual fear conditioning, the water maze task, and spatial working memory. Cortical atrophy was significantly exacerbated in TBI animals exposed to ELS compared with normal-reared TBI animals. Changes in corticosterone in response to restraint stress were prolonged in TBI animals that received ELS compared with TBI animals that were normally reared or sham animals that received ELS. Our findings indicate that ELS is a risk factor for worsened outcome after TBI, and results in persistent learning and memory deficits, worsened cortical pathology, and an exacerbation of the hormonal stress response.
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Affiliation(s)
- Chantal M Sanchez
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David J Titus
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicole M Wilson
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Julie E Freund
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Coleen M Atkins
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Ducos Y, Aghakhani N. Prognostic factors for unfavorable outcome after mild traumatic brain injury. A review of literature. Neurochirurgie 2020; 67:259-264. [PMID: 32593671 DOI: 10.1016/j.neuchi.2020.04.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/08/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unfavorable outcomes occur in 15-20% of patients with mild traumatic brain injury (mTBI). Early identification of patients at risk of unfavorable outcome is crucial for suitable management to be initiated, increasing the chances of full recovery. Many studies have been published on prognostic factors, but are not of a high level of evidence and certainty. A number of factors have been proposed and predictive models have been constructed that, although attractive, have not yet been externally validated. OBJECTIVES A review of literature (systematic search of PubMed and Google Scholar) assembled relevant available information about prognostic factors for unfavorable outcome after mTBI. We discuss the consistency of these findings, and the possibility and difficulty of using these factors in a daily practice. RESULTS It appears that the strongest and most consistent predictors are the number, severity and duration of symptoms present in the first few days after the trauma.
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Affiliation(s)
- Y Ducos
- Department of Neurosurgery, Paris, France
| | - N Aghakhani
- Department of Neurosurgery, Paris, France; Center for Evaluation and Multidisciplinary Care of Mild Traumatic Brain Injury, Bicêtre University Hospital, Paris, France.
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13
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Alcohol and Drug Use Before and During the First Year After Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:E51-E60. [PMID: 28926484 DOI: 10.1097/htr.0000000000000341] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare individuals with mild and moderate/severe traumatic brain injury (TBI) on alcohol and drug use and substance use disorders before and in the first year post-TBI; to explore sociodemographic and injury-related variables associated with substance use disorders. PARTICIPANTS A total of 225 adults hospitalized in a level I trauma center after TBI. DESIGN Observational cohort study with retrospective (pre-TBI) and prospective (4, 8, and 12 months post-TBI) assessments. MAIN MEASURES Mini International Neuropsychiatric Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS The percentage of participants using alcohol or drug declined shortly after the injury (4 months) but increased closer to preinjury levels by the end of the first year. Post-TBI alcohol use was higher after mild than moderate/severe TBI, but drug use was similar. About 11% of participants met criteria for a substance use disorder in the first year after TBI. Younger age, not being in a relationship, and suspected substance intoxication at the time of TBI were associated with the presence of a post-TBI substance use disorder. CONCLUSION Individuals with milder injuries return to alcohol use earlier than those with more severe injuries. Given that substance use may alter recovery, preventive recommendations and systematic follow-ups are warranted regardless of injury severity and access to rehabilitation.
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Weil ZM, Karelina K, Corrigan JD. Does pediatric traumatic brain injury cause adult alcohol misuse: Combining preclinical and epidemiological approaches. Exp Neurol 2019; 317:284-290. [DOI: 10.1016/j.expneurol.2019.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 12/27/2022]
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15
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Yue JK, Ngwenya LB, Upadhyayula PS, Deng H, Winkler EA, Burke JF, Lee YM, Robinson CK, Ferguson AR, Lingsma HF, Cnossen MC, Pirracchio R, Korley FK, Vassar MJ, Yuh EL, Mukherjee P, Gordon WA, Valadka AB, Okonkwo DO, Manley GT. Emergency department blood alcohol level associates with injury factors and six-month outcome after uncomplicated mild traumatic brain injury. J Clin Neurosci 2017; 45:293-298. [PMID: 28789959 DOI: 10.1016/j.jocn.2017.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
The relationship between blood alcohol level (BAL) and mild traumatic brain injury (mTBI) remains in need of improved characterization. Adult patients suffering mTBI without intracranial pathology on computed tomography (CT) from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with emergency department (ED) Glasgow Coma Scale (GCS) 13-15 and recorded blood alcohol level (BAL) were extracted. BAL≥80-mg/dl was set as proxy for excessive use. Multivariable regression was performed for patients with six-month Glasgow Outcome Scale-Extended (GOSE; functional recovery) and Wechsler Adult Intelligence Scale Processing Speed Index Composite Score (WAIS-PSI; nonverbal processing speed), using BAL≥80-mg/dl and <80-mg/dl cohorts, adjusting for demographic/injury factors. Overall, 107 patients were aged 42.7±16.8-years, 67.3%-male, and 80.4%-Caucasian; 65.4% had BAL=0-mg/dl, 4.6% BAL<80-mg/dl, and 30.0% BAL≥80-mg/dl (range 100-440-mg/dl). BAL differed across loss of consciousness (LOC; none: median 0-mg/dl [interquartile range (IQR) 0-0], <30-min: 0-mg/dl [0-43], ≥30-min: 224-mg/dl [50-269], unknown: 108-mg/dl [0-232]; p=0.002). GCS<15 associated with higher BAL (19-mg/dl [0-204] vs. 0-mg/dl [0-20]; p=0.013). On univariate analysis, BAL≥80-mg/dl associated with less-than-full functional recovery (GOSE≤7; 38.1% vs. 11.5%; p=0.025) and lower WAIS-PSI (92.4±12.7, 30th-percentile vs. 105.1±11.7, 63rd-percentile; p<0.001). On multivariable regression BAL≥80-mg/dl demonstrated an odds ratio of 8.05 (95% CI [1.35-47.92]; p=0.022) for GOSE≤7 and an adjusted mean decrease of 8.88-points (95% CI [0.67-17.09]; p=0.035) on WAIS-PSI. Day-of-injury BAL>80-mg/dl after uncomplicated mTBI was associated with decreased GCS score and prolongation of reported LOC. BAL may be a biomarker for impaired return to baseline function and decreased nonverbal processing speed at six-months postinjury. Future confirmatory studies are needed.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Young M Lee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Caitlin K Robinson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maryse C Cnossen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Division of Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mary J Vassar
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Esther L Yuh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Wayne A Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA.
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The Prevalence of Traumatic Brain Injury Among People With Co-Occurring Mental Health and Substance Use Disorders. J Head Trauma Rehabil 2017; 32:E65-E74. [DOI: 10.1097/htr.0000000000000249] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Dretsch MN, Silverberg N, Gardner AJ, Panenka WJ, Emmerich T, Crynen G, Ait-Ghezala G, Chaytow H, Mathura V, Crawford FC, Iverson GL. Genetics and Other Risk Factors for Past Concussions in Active-Duty Soldiers. J Neurotrauma 2017; 34:869-875. [DOI: 10.1089/neu.2016.4480] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael N. Dretsch
- United States Army Aeromedical Research Laboratory, Fort Rucker, Alabama
- Human Dimension Division (HDD), Headquarters Army Training and Doctrine Command (HQ TRADOC), Fort Eustis, Virginia
| | - Noah Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
- Roskamp Institute, Sarasota, Florida
| | - Andrew J. Gardner
- Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital and Home Base, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
- Defense and Veterans Brain Injury Center, Bethesda, Maryland
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Abstract
OBJECTIVES To examine the effect of pre-injury alcohol use, acute alcohol intoxication, and post-injury alcohol use on outcome from mild to moderate traumatic brain injury (TBI). METHODS Prospective inception cohort of patients who presented to the Emergency Department with mild to moderate TBI and had a blood alcohol level (BAL) taken for clinical purposes. Those who completed the 1-year outcome assessment were eligible for this study (N=91). Outcomes of interest were the count of post-concussion symptoms (British Columbia Post-Concussion Symptom Inventory), low neuropsychological test scores (Neuropsychological Assessment Battery), and abnormal regions of interest on diffusion tensor imaging (low fractional anisotropy). The main predictors were pre-injury alcohol consumption (Cognitive Lifetime Drinking History interview), BAL, and post-injury alcohol use. RESULTS The alcohol use variables were moderately to strongly inter-correlated. None of the alcohol use variables (whether continuous or categorical) were related to 1-year TBI outcomes in generalized linear modeling. Participants in this cohort generally had a good clinical outcome, regardless of their pre-, peri-, and post-injury alcohol use. CONCLUSIONS Alcohol may not significantly alter long-term outcome from mild to moderate TBI. (JINS, 2016, 22, 816-827).
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The six-year outcome of alcohol use disorders in men: A population based study from India. Drug Alcohol Depend 2016; 162:107-15. [PMID: 26994665 PMCID: PMC4841788 DOI: 10.1016/j.drugalcdep.2016.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the large and growing public health problem of alcohol use disorders (AUD) in India there is a dearth of evidence about the longitudinal outcomes in AUD. The aim of this study is to describe the course and outcomes of AUD in a population based sample of men in India. METHODS A community cohort of 1899 adult (18-49 years at baseline) men who participated in a cross-sectional survey in Goa, India between 2006 and 08, were re-interviewed face to face 6 years later (2012-14). A range of outcomes including social problems (e.g., workplace problems, domestic violence), morbidity (e.g., range of physical and mental health problems), biological parameters (e.g., mean corpuscular volume [MCV], gamma-glutamyl transpeptidase [GGT]) and mortality were measured at follow up. For the association of AUD at baseline with outcomes at follow-up, multivariable logistic regression was used to estimate odds ratios (OR). Analyses were weighted to account for baseline sampling design, age distribution, rural and urban sample sizes, number of adults aged 18-49 years in the household (at baseline), and non-response (at baseline). RESULTS 1514 (79.7%) were seen at follow-up; a loss to follow up of 20.3%. At follow up, 3.7% of baseline non-drinkers and 15.0% of baseline casual drinkers had AUD. 46.9% of baseline hazardous drinkers and 55.4% baseline harmful drinkers continued to have AUD at follow up. Of those with AUD at baseline, 21.8% had stopped drinking at follow-up. Compared to being abstinent, harmful drinking at baseline was associated with several outcomes at follow-up: workplace/social problems, hypertension, death, tobacco use, suicidality, anxiety disorders, and raised GGT (p<0.002). Hazardous drinking at baseline was associated with tobacco use and raised GGT and MCV (p<0.002) at follow-up. CONCLUSION Our findings of high persistent and new AUD in the community and the association with a range of long term adverse events are an important addition to the limited evidence about the course and outcomes of AUD in India, which have the potential for informing health policy.
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Weil ZM, Corrigan JD, Karelina K. Alcohol abuse after traumatic brain injury: Experimental and clinical evidence. Neurosci Biobehav Rev 2016; 62:89-99. [DOI: 10.1016/j.neubiorev.2016.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/16/2015] [Accepted: 01/21/2016] [Indexed: 01/06/2023]
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Pagulayan KF, Temkin NR, Machamer JE, Dikmen SS. Patterns of Alcohol Use after Traumatic Brain Injury. J Neurotrauma 2016; 33:1390-6. [PMID: 26530335 DOI: 10.1089/neu.2015.4071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alcohol misuse and traumatic brain injury (TBI) frequently co-occur. The negative consequences of this interaction are well documented, but the patterns of long-term post-injury alcohol consumption are less clear. This study examined patterns of alcohol use among 170 adults with a history of complicated mild to severe TBI. Participants were recruited from a Level 1 Trauma Center at the time of their injury and completed evaluations at 1 month, 6 months, 12 months, and 3-5 years post-injury. Pre-injury alcohol use was also assessed at the time of the 1-month assessment. A modified Quantity-Frequency Index of alcohol consumption was then calculated for each time point. The results revealed high levels of pre-injury alcohol consumption, followed by a reduction in consumption at 1-month post-injury. A significant increase in consumption was noted by 6 months post-injury, followed by more gradual increases in alcohol consumption at 1 year. Post-injury alcohol consumption was comparable to the general public at 6 months, 12 months, and 3-5 years post-injury. These results suggest that the first 6 months post-injury may be the critical window of opportunity for alcohol intervention.
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Affiliation(s)
- Kathleen F Pagulayan
- 1 VA Puget Sound Mental Illness Research, Education and Clinical Center , Seattle, Washington.,2 University of Washington Department of Psychiatry and Behavioral Medicine, Seattle, Washington
| | - Nancy R Temkin
- 3 University of Washington Department of Rehabilitation Medicine, Seattle, Washington.,4 University of Washington Department of Neurological Surgery, Seattle, Washington.,5 University of Washington Department of Biostatistics, Seattle, Washington
| | - Joan E Machamer
- 3 University of Washington Department of Rehabilitation Medicine, Seattle, Washington
| | - Sureyya S Dikmen
- 2 University of Washington Department of Psychiatry and Behavioral Medicine, Seattle, Washington.,3 University of Washington Department of Rehabilitation Medicine, Seattle, Washington.,4 University of Washington Department of Neurological Surgery, Seattle, Washington
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Co-Occurring Traumatic Brain Injury, PTSD Symptoms, and Alcohol Use in Veterans. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9513-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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24
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Bryce S, Spitz G, Ponsford J. Screening for Substance Use Disorders Following Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:E40-8. [DOI: 10.1097/htr.0000000000000091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Lim YW, Meyer NP, Shah AS, Budde MD, Stemper BD, Olsen CM. Voluntary Alcohol Intake following Blast Exposure in a Rat Model of Mild Traumatic Brain Injury. PLoS One 2015; 10:e0125130. [PMID: 25910266 PMCID: PMC4409117 DOI: 10.1371/journal.pone.0125130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/11/2015] [Indexed: 12/24/2022] Open
Abstract
Alcoholism is a frequent comorbidity following mild traumatic brain injury (mTBI), even in patients without a previous history of alcohol dependence. Despite this correlational relationship, the extent to which the neurological effects of mTBI contribute to the development of alcoholism is unknown. In this study, we used a rodent blast exposure model to investigate the relationship between mTBI and voluntary alcohol drinking in alcohol naïve rats. We have previously demonstrated in Sprague Dawley rats that blast exposure leads to microstructural abnormalities in the medial prefrontal cortex (mPFC) and other brain regions that progress from four to thirty days. The mPFC is a brain region implicated in alcoholism and drug addiction, although the impact of mTBI on drug reward and addiction using controlled models remains largely unexplored. Alcohol naïve Sprague Dawley rats were subjected to a blast model of mTBI (or sham conditions) and then tested in several common measures of voluntary alcohol intake. In a seven-week intermittent two-bottle choice alcohol drinking test, sham and blast exposed rats had comparable levels of alcohol intake. In a short access test session at the conclusion of the two-bottle test, blast rats fell into a bimodal distribution, and among high intake rats, blast treated animals had significantly elevated intake compared to shams. We found no effect of blast when rats were tested for an alcohol deprivation effect or compulsive drinking in a quinine adulteration test. Throughout the experiment, alcohol drinking was modest in both groups, consistent with other studies using Sprague Dawley rats. In conclusion, blast exposure had a minimal impact on overall alcohol intake in Sprague Dawley rats, although intake was increased in a subpopulation of blast animals in a short access session following intermittent access exposure.
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Affiliation(s)
- Yi Wei Lim
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Nathan P. Meyer
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Alok S. Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America
| | - Matthew D. Budde
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America
| | - Brian D. Stemper
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America
| | - Christopher M. Olsen
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
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26
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Teng SX, Katz PS, Maxi JK, Mayeux JP, Gilpin NW, Molina PE. Alcohol exposure after mild focal traumatic brain injury impairs neurological recovery and exacerbates localized neuroinflammation. Brain Behav Immun 2015; 45:145-56. [PMID: 25489880 PMCID: PMC4342330 DOI: 10.1016/j.bbi.2014.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/31/2014] [Accepted: 11/13/2014] [Indexed: 01/05/2023] Open
Abstract
Traumatic brain injury (TBI) represents a leading cause of morbidity and mortality among young individuals. Alcohol abuse is a risk factor associated with increased TBI incidence. In addition, up to 26% of TBI patients engage in alcohol consumption after TBI. Limited preclinical studies have examined the impact of post-injury alcohol exposure on TBI recovery. The aim of this study was to determine the isolated and combined effects of TBI and alcohol on cognitive, behavioral, and physical recovery, as well as on associated neuroinflammatory changes. Male Sprague-Dawley rats (∼300g) were subjected to a mild focal TBI by lateral fluid percussion (∼30PSI, ∼25ms) under isoflurane anesthesia. On day 4 after TBI, animals were exposed to either sub-chronic intermittent alcohol vapor (95% ethanol 14h on/10h off; BAL∼200mg/dL) or room air for 10days. TBI induced neurological dysfunction reflected by an increased neurological severity score (NSS) showed progressive improvement in injured animals exposed to room air (TBI/air). In contrast, TBI animals exposed to alcohol vapor (TBI/alcohol) showed impaired NSS recovery throughout the 10-day period of alcohol exposure. Open-field exploration test revealed an increased anxiety-like behavior in TBI/alcohol group compared to TBI/air group. Additionally, alcohol-exposed animals showed decreased locomotion and impaired novel object recognition. Immunofluorescence showed enhanced reactive astrocytes, microglial activation, and HMGB1 expression localized to the injured cortex of TBI/alcohol as compared to TBI/air animals. The expression of neuroinflammatory markers showed significant positive correlation with NSS. These findings indicated a close relationship between accentuated neuroinflammation and impaired neurological recovery from post-TBI alcohol exposure. The clinical implications of long-term consequences in TBI patients exposed to alcohol during recovery warrant further investigation.
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Affiliation(s)
- Sophie X Teng
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Paige S Katz
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - John K Maxi
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Jacques P Mayeux
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Nicholas W Gilpin
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Patricia E Molina
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States.
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Lowing JL, Susick LL, Caruso JP, Provenzano AM, Raghupathi R, Conti AC. Experimental traumatic brain injury alters ethanol consumption and sensitivity. J Neurotrauma 2014; 31:1700-10. [PMID: 24934382 DOI: 10.1089/neu.2013.3286] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Altered alcohol consumption patterns after traumatic brain injury (TBI) can lead to significant impairments in TBI recovery. Few preclinical models have been used to examine alcohol use across distinct phases of the post-injury period, leaving mechanistic questions unanswered. To address this, the aim of this study was to describe the histological and behavioral outcomes of a noncontusive closed-head TBI in the mouse, after which sensitivity to and consumption of alcohol were quantified, in addition to dopaminergic signaling markers. We hypothesized that TBI would alter alcohol consumption patterns and related signal transduction pathways that were congruent to clinical observations. After midline impact to the skull, latency to right after injury, motor deficits, traumatic axonal injury, and reactive astrogliosis were evaluated in C57BL/6J mice. Amyloid precursor protein (APP) accumulation was observed in white matter tracts at 6, 24, and 72 h post-TBI. Increased intensity of glial fibrillary acidic protein (GFAP) immunoreactivity was observed by 24 h, primarily under the impact site and in the nucleus accumbens, a striatal subregion, as early as 72 h, persisting to 7 days, after TBI. At 14 days post-TBI, when mice were tested for ethanol sensitivity after acute high-dose ethanol (4 g/kg, intraperitoneally), brain-injured mice exhibited increased sedation time compared with uninjured mice, which was accompanied by deficits in striatal dopamine- and cAMP-regulated neuronal phosphoprotein, 32 kDa (DARPP-32) phosphorylation. At 17 days post-TBI, ethanol intake was assessed using the Drinking-in-the-Dark paradigm. Intake across 7 days of consumption was significantly reduced in TBI mice compared with sham controls, paralleling the reduction in alcohol consumption observed clinically in the initial post-injury period. These data demonstrate that TBI increases sensitivity to ethanol-induced sedation and affects downstream signaling mediators of striatal dopaminergic neurotransmission while altering ethanol consumption. Examining TBI effects on ethanol responsitivity will improve our understanding of alcohol use post-TBI in humans.
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Affiliation(s)
- Jennifer L Lowing
- 1 John D. Dingell VA Medical Center, Wayne State University School of Medicine , Detroit, Michigan
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Lange RT, Shewchuk JR, Rauscher A, Jarrett M, Heran MKS, Brubacher JR, Iverson GL. A Prospective Study of the Influence of Acute Alcohol Intoxication Versus Chronic Alcohol Consumption on Outcome Following Traumatic Brain Injury. Arch Clin Neuropsychol 2014; 29:478-95. [DOI: 10.1093/arclin/acu027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Niemelä M, Kinnunen L, Paananen R, Hakko H, Merikukka M, Karttunen V, Gissler M, Räsänen S. Parents' traumatic brain injury increases their children's risk for use of psychiatric care: the 1987 Finnish Birth Cohort study. Gen Hosp Psychiatry 2014; 36:337-41. [PMID: 24556261 DOI: 10.1016/j.genhosppsych.2013.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) of a parent causes significant changes in their family life and parent-children relationships. However, the number of children affected by parental TBI and the long-term consequences for these children remain unknown. We estimated the prevalence of children affected by parental TBI and investigated whether these children had greater use of psychiatric services than their peers. METHODS This a retrospective population-based register study. All 60,069 children born in Finland in 1987 were followed up through national health and social registers from 1987 to 2008. RESULTS During the 21-year follow-up, 1532 (2.6%) children had a parent with TBI. Overall, 22.5% of those having a parent with TBI were treated in specialized psychiatric care. Use of psychiatric care was significantly increased among those cohort members with a parent with mild [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.37-2.38] or severe (OR 1.49, 95% CI 1.12-1.98) TBI compared to their peers. CONCLUSIONS Parental TBI is associated with increased use of specialized psychiatric services by children. Adult health care services must have appropriate systems in place to address the psychosocial needs and support the welfare and development of children of patients with TBI.
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Affiliation(s)
- Mika Niemelä
- National Institute for Health and Welfare, Child and Adolescent Mental Health Unit, Helsinki, Finland.
| | - Lotta Kinnunen
- Oulu University Hospital, Department of Psychiatry, Oulu, Finland
| | - Reija Paananen
- National Institute for Health and Welfare, Department of Children, Young People and Families Oulu, Finland
| | - Helinä Hakko
- Oulu University Hospital, Department of Psychiatry, Oulu, Finland
| | - Marko Merikukka
- National Institute for Health and Welfare, Department of Children, Young People and Families Oulu, Finland
| | - Vesa Karttunen
- Oulu University Hospital, Department of Neurology, Oulu, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Information Department, Helsinki, Finland, Nordic School of Public Health NHV, Gothenburg, Sweden
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Munce SEP, Laan RV, Levy C, Parsons D, Jaglal SB. Systems analysis of community and health services for acquired brain injury in Ontario, Canada. Brain Inj 2014; 28:1042-51. [DOI: 10.3109/02699052.2014.890744] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Conley RN, Longmuir GA. Brain and Spinal Cord. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vaaramo K, Puljula J, Tetri S, Juvela S, Hillbom M. Head trauma sustained under the influence of alcohol is a predictor for future traumatic brain injury: a long-term follow-up study. Eur J Neurol 2013; 21:293-8. [DOI: 10.1111/ene.12302] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- K. Vaaramo
- Department of Neurology; University of Oulu; Oulu University Hospital; Oulu Finland
| | - J. Puljula
- Department of Neurology; University of Oulu; Oulu University Hospital; Oulu Finland
| | - S. Tetri
- Department of Neurosurgery; University of Oulu; Oulu University Hospital; Oulu Finland
| | - S. Juvela
- Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
| | - M. Hillbom
- Department of Neurology; University of Oulu; Oulu University Hospital; Oulu Finland
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Durazzo TC, Abadjian L, Kincaid A, Bilovsky-Muniz T, Boreta L, Gauger GE. The influence of chronic cigarette smoking on neurocognitive recovery after mild traumatic brain injury. J Neurotrauma 2013; 30:1013-22. [PMID: 23421788 DOI: 10.1089/neu.2012.2676] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The majority of the approximately 1.7 million civilians in the United States who seek emergency care for traumatic brain injury (TBI) are classified as mild (MTBI). Premorbid and comorbid conditions that commonly accompany MTBI may influence neurocognitive and functional recovery. This study assessed the influence of chronic smoking and hazardous alcohol consumption on neurocognitive recovery after MTBI. A comprehensive neurocognitive battery was administered to 25 non-smoking MTBI participants (nsMTBI), 19 smoking MTBI (sMTBI) 38 ± 22 days (assessment point 1: AP1) and 230 ± 36 (assessment point 2: AP2) days after injury. Twenty non-smoking light drinkers served as controls (CON). At AP1, nsMTBI and sMTBI were inferior to CON on measures of auditory-verbal learning and memory; nsMTBI performed more poorly than CON on processing speed and global neurocognition, and sMTBI performed worse than CON on working memory measures; nsMTBI were inferior to sMTBI on visuospatial memory. Over the AP1-AP2 interval, nsMTBI showed significantly greater improvement than sMTBI on measures of processing speed, visuospatial learning and memory, visuospatial skills, and global neurocognition, whereas sMTBI only showed significant improvement on executive skills. At AP2, sMTBI remained inferior to CON on auditory-verbal learning and auditory-verbal memory; there were no significant differences between nsMTBI and CON or among nsMTBI and sMTBI on any domain at AP2. Hazardous alcohol consumption was not significantly associated with change in any neurocognitive domain. For sMTBI, over the AP1-AP2 interval, greater lifetime duration of smoking and pack-years were related to significantly less improvement on multiple domains. Results suggest consideration of the effects of chronic cigarette smoking is necessary to understand the potential factors influencing neurocognitive recovery after MTBI.
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Affiliation(s)
- Timothy C Durazzo
- Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, California 94121, USA.
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The effect of blood alcohol level and preinjury chronic alcohol use on outcome from severe traumatic brain injury in Hispanics, anglo-Caucasians, and African-americans. J Head Trauma Rehabil 2013; 27:361-9. [PMID: 22955101 DOI: 10.1097/htr.0b013e318266735c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine (a) ethnic differences in blood alcohol level (BAL) and preinjury chronic alcohol use (PI-ETOH) within a severe closed head injury (CHI) sample and (b) the main and interaction effects of BAL, PI-ETOH, and ethnicity on functional outcome following severe CHI. PARTICIPANTS A total of 434 Hispanic, Anglo-Caucasian, and African-American individuals with severe CHI. DESIGN Retrospective cohort study. SETTING Consecutive admissions to a level 1 trauma center. MAIN MEASURES After admission to the trauma center, BAL was collected for each patient. Additional information regarding PI-ETOH was collected in a subset of patients (N = 116). Functional outcome was measured using the Disability Rating Scale (DRS) at 6 months after injury. RESULTS A one-way analysis of variance revealed ethnic differences in mean BAL. Hierarchical multiple regression indicated that BAL did not predict DRS outcomes after controlling for pertinent covariates. An interaction effect between PI-ETOH and ethnicity was observed, such that presence of chronic alcohol use predicted worse functional outcome for Anglo-Caucasians and African-Americans, but more favorable outcome for Hispanics. CONCLUSIONS Ethnic differences in BALs within our severe traumatic brain injury sample mirrored ethnic drinking patterns observed in the general population, with Hispanics having the highest BALs. A paradoxical relationship between PI-ETOH and functional outcome was observed for Hispanics.
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A Randomized Controlled Trial of Brief Intervention for Problem Alcohol Use in Persons With Traumatic Brain Injury. J Head Trauma Rehabil 2012; 27:319-30. [DOI: 10.1097/htr.0b013e318269838c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Olson-Madden JH, Brenner LA, Corrigan JD, Emrick CD, Britton PC. Substance use and mild traumatic brain injury risk reduction and prevention: a novel model for treatment. Rehabil Res Pract 2012; 2012:174579. [PMID: 22685663 PMCID: PMC3363008 DOI: 10.1155/2012/174579] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/15/2012] [Accepted: 02/21/2012] [Indexed: 11/17/2022] Open
Abstract
Traumatic brain injury (TBI) and substance use disorders (SUDs) frequently co-occur. Individuals with histories of alcohol or other drug use are at greater risk for sustaining TBI, and individuals with TBI frequently misuse substances before and after injury. Further, a growing body of literature supports the relationship between comorbid histories of mild TBI (mTBI) and SUDs and negative outcomes. Alcohol and other drug use are strongly associated with risk taking. Disinhibition, impaired executive function, and/or impulsivity as a result of mTBI also contribute to an individual's proclivity towards risk-taking. Risk-taking behavior may therefore, be a direct result of SUD and/or history of mTBI, and risky behaviors may predispose individuals for subsequent injury or continued use of substances. Based on these findings, evaluation of risk-taking behavior associated with the co-occurrence of SUD and mTBI should be a standard clinical practice. Interventions aimed at reducing risky behavior among members of this population may assist in decreasing negative outcomes. A novel intervention (Substance Use and Traumatic Brain Injury Risk Reduction and Prevention (STRRP)) for reducing and preventing risky behaviors among individuals with co-occurring mTBI and SUD is presented. Areas for further research are discussed.
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Affiliation(s)
- Jennifer H. Olson-Madden
- Mental Illness Research, Education, and Clinical Center (MIRECC), Eastern Colorado Health Care System (ECHCS) Veterans Affairs Medical Center, Denver, CO 80220, USA
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Aurora, CO 80111, USA
| | - Lisa A. Brenner
- Mental Illness Research, Education, and Clinical Center (MIRECC), Eastern Colorado Health Care System (ECHCS) Veterans Affairs Medical Center, Denver, CO 80220, USA
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Aurora, CO 80111, USA
- Departments of Neurology and Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, CO 80111, USA
| | - John D. Corrigan
- Department of Physical Medicine and Rehabilitation, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, USA
| | - Chad D. Emrick
- Outpatient Substance Abuse Treatment Program, Eastern Colorado Health Care System (ECHCS) Veterans Affairs Medical Center, Denver, CO 80220, USA
| | - Peter C. Britton
- Center of Excellence, Canandaigua Veterans Affairs Medical Center, Canandaigua, NY 14424, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
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Schofield P, Butler T, Hollis S, D'Este C. Are prisoners reliable survey respondents? A validation of self-reported traumatic brain injury (TBI) against hospital medical records. Brain Inj 2010; 25:74-82. [PMID: 21117913 DOI: 10.3109/02699052.2010.531690] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To compare prisoners' self-reported history of TBI associated with hospital attendance with details extracted from relevant hospital medical records and to identify factors associated with the level of agreement between the two sources. METHODS From a sample of prison entrants, this study obtained a history of TBIs for which medical attention was sought at a hospital. Audit tools were developed for data extraction relevant to any possible TBI from records at a total of 23 hospitals located within New South Wales, Australia. The level of agreement between self-report and hospital records was compared in relation to demographic, psychological and criminographic characteristics. RESULTS Of the 200 participants in the study, 164 (82%) reported having sustained a past TBI giving a total of 420 separate TBI incidents. Of these, 156 (37%) were alleged to have resulted in attendance at a hospital emergency department including 112 (72%) at a hospital accessible for the validation exercise. For 93/112 (83%) of reported TBIs, a corresponding hospital medical record was located of which 78/112 (70%) supported the occurrence of a TBI. Lower education and a lifetime history of more than seven TBIs were associated with less agreement between self-report and medical record data with regard to specific details of the TBI. CONCLUSIONS Overall, these findings suggest that prisoners' self-report of TBI is generally accurate when compared with the 'gold standard' of hospital medical record. This finding is contrary to the perception of this group as 'dishonest' and 'unreliable'.
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Affiliation(s)
- Peter Schofield
- Neuropsychiatry Service, Hunter New England Health, NSW, Australia.
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Olson-Madden JH, Brenner L, Harwood JE, Emrick CD, Corrigan JD, Thompson C. Traumatic Brain Injury and Psychiatric Diagnoses in Veterans Seeking Outpatient Substance Abuse Treatment. J Head Trauma Rehabil 2010; 25:470-9. [DOI: 10.1097/htr.0b013e3181d717a7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Opreanu RC, Kuhn D, Basson MD. Influence of alcohol on mortality in traumatic brain injury. J Am Coll Surg 2010; 210:997-1007. [PMID: 20510810 PMCID: PMC3837571 DOI: 10.1016/j.jamcollsurg.2010.01.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 01/29/2010] [Accepted: 01/29/2010] [Indexed: 11/20/2022]
Affiliation(s)
- Razvan C Opreanu
- Department of Surgery, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA
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Abstract
BACKGROUND Recent studies have suggested that moderate doses of ethanol (ETOH) before traumatic brain injury (TBI) may have a neuroprotective role. OBJECTIVE : The objective of this study is to investigate the effects of serum ETOH levels on outcomes after TBI. Our hypothesis was that ETOH exposure is associated with improved survival in severe TBI patients and that the serum ETOH levels on admission correlate with survival. METHODS All patients sustaining severe TBI (head abbreviated injury score >or=3) admitted to the Surgical Intensive Care Unit at the Los Angeles County + University of Southern California Medical Center from January 2000 to December 2005 who had a serum ETOH level measured on admission were analyzed. Patients were classified into ETOH-positive and ETOH-negative groups, according to the serum ETOH levels and compared for differences in outcomes using logistic regression to adjust for clinically and statistically relevant confounding factors. RESULTS During the 5-year study period, 482 severe TBI patients admitted to the Surgical Intensive Care Unit at Los Angeles County + University of Southern California Medical Center had a serum ETOH level measured on admission. A total of 47% of severe TBI patients were tested for ETOH. ETOH levels were positive in 37% (179) and negative in 63% (303) of the TBI patients. The ETOH-positive group had a higher percentage of males (91% vs. 79%, p = 0.001), lower percentage of penetrating injuries (9% vs. 20%, p = 0.002), and lower injury severity score (25.7 +/- 11.5 vs. 28.4 +/- 14.1, p = 0.05). Overall mortality was significantly lower in the ETOH-positive group at 27% versus 40% (odds ratio = 0.55, 95% confidence interval: 0.37-0.82; p = 0.004). This survival benefit remained significant after multivariable analysis (adjusted odds ratio = 0.54, 95% confidence interval: 0.31-0.92; adjusted p = 0.02). The mean serum ETOH level was significantly higher for survivors than for nonsurvivors (0.11 +/- 0.21 vs. 0.05 +/- 0.10, p < 0.001). The serum ETOH levels significantly correlated with the probability of survival (r = 0.21, p < 0.001), but this correlation was not strong as shown by the low r value. CONCLUSION The results of this study suggest that elevated ETOH serum levels are independently associated with higher survival in patients with severe traumatic brain injuries. Additional research is required to further investigate the mechanism and potential therapeutic implications of this association.
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De Guise E, Leblanc J, Dagher J, Lamoureux J, Jishi AA, Maleki M, Marcoux J, Feyz M. Early outcome in patients with traumatic brain injury, pre-injury alcohol abuse and intoxication at time of injury. Brain Inj 2009; 23:853-65. [DOI: 10.1080/02699050903283221] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Winqvist S, Jokelainen J, Luukinen H, Hillbom M. Parental alcohol misuse is a powerful predictor for the risk of traumatic brain injury in childhood. Brain Inj 2009; 21:1079-85. [PMID: 17852100 DOI: 10.1080/02699050701553221] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the positive relationship between parental alcohol use and children's injuries is well established, it is not known whether parental alcohol misuse is a risk factor for traumatic brain injuries (TBIs) of their children and whether subjects with childhood TBI have hazardous drinking habits in adolescence. METHODS The authors conducted a longitudinal cohort study at Oulu University Hospital. The cohort consisted of 12 058 subjects born in 1966, of which 207 had sustained TBI before the age of 14 years. Data on parental alcohol problems were obtained from the Finnish Hospital Discharge Register and the adolescents' drinking habits were analysed based on a postal inquiry at the age of 14 years. RESULTS Parental alcohol misuse (RR 1.99, CI 1.19-3.33) and male gender (RR 1.53, CI 1.12-2.08) significantly predicted the risk of childhood TBI. Drinking to intoxication at the age of 14 was significantly associated with parental alcohol misuse (RR 1.62, CI 1.34-1.96), belonging to a one-parent family (RR 1.80, CI 1.61-2.02) and mild TBI (RR 1.67, CI 1.20-2.33). CONCLUSIONS It was observed that parental alcohol misuse is a major risk factor for TBI in children and drinking to intoxication is a common drinking pattern of adolescents who have sustained TBI in childhood.
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Affiliation(s)
- Satu Winqvist
- Department of Neurology, University of Oulu and Oulu University Hospital, Box 25, FIN-90029 OYS, Finland.
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Cunningham R, Knox L, Fein J, Harrison S, Frisch K, Walton M, Dicker R, Calhoun D, Becker M, Hargarten SW. Before and After the Trauma Bay: The Prevention of Violent Injury Among Youth. Ann Emerg Med 2009; 53:490-500. [DOI: 10.1016/j.annemergmed.2008.11.014] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 11/03/2008] [Accepted: 11/19/2008] [Indexed: 11/16/2022]
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Winqvist S, Luukinen H, Jokelainen J, Lehtilahti M, Näyhä S, Hillbom M. Recurrent traumatic brain injury is predicted by the index injury occurring under the influence of alcohol. Brain Inj 2009; 22:780-5. [PMID: 18787988 DOI: 10.1080/02699050802339397] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Little is known of the role of alcohol intoxication as a risk factor for recurrent traumatic brain injuries (TBI). This study was a population-based longitudinal study to investigate this problem. METHODS The record linkage technique was used and data gathered from the Finnish Hospital Discharge Register, hospital records and by a questionnaire of family characteristics regarding the 12 058 subjects forming the Northern Finland Birth Cohort of 1966. Excluded were TBI subjects injured before the age of 12 years. RESULTS Of the 236 patients who had survived their first (mainly mild) TBI, 21 had had a recurrent TBI and three of them two recurrent TBIs during the follow-up period (from 1978-2000). An alcohol-related first injury (RR 4.41, 95% CI 1.53-12.70) and urban place of birth (RR 4.39, 95% CI 1.68-11.48) were significant independent predictors of recurrent TBI. A significant positive correlation between the first and recurrent TBIs with respect to alcohol involvement (rs = 0.61, p = 0.003) was observed. CONCLUSIONS A first TBI related to alcohol drinking is predictive of recurrent TBI, which will often similarly be alcohol-related. The risk of recurrent injury seems to extend over several years after the first TBI. To prevent recurrence, efforts should be made to identify those with an alcohol-related first TBI. A brief intervention focused on drinking habits is needed as an immediate preventive measure.
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Affiliation(s)
- Satu Winqvist
- Department of Neurology, University of Oulu, Finland.
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Faria JWVD, Nishioka SDA, Arbex GL, Alarcão GG, Freitas WBD. Occurrence of severe and moderate traumatic brain injury in patients attended in a Brazilian Teaching Hospital: epidemiology and dosage of alcoholemy. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:69-73. [PMID: 18392418 DOI: 10.1590/s0004-282x2008000100016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 11/27/2007] [Indexed: 11/22/2022]
Abstract
This study aimed at observing aspects of epidemiology in order to investigate the use of alcohol in patients older than 18 with severe and moderate traumatic brain injury, which were attended in the Clinics Hospital of the University of Uberlândia. Positive alcoholemy was found in 39.3% of the patients. Of the 33 positive exams alcoholemy was found higher than 60 mg/dL in 28 (84.6%). There was not significant relation between alcoholemy levels and trauma severity. The major prevalence occurred on Saturdays nights. The most frequent types of external causes were transportation accidents (64.74) followed by accidental falls (17.27%) and physical aggression (16.55%). 93.9% of the patients with positive alcoholemy were men aged 20-29. 24.2% of the ones with positive alcoholemy died yet no significant difference was found in the study of the ones with negative alcoholemy (n=51) (p=0.93); RR= 0.9; IC95%=0.40-2.08.
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Tanios MA, de Wit M, Epstein SK, Devlin JW. Perceived barriers to the use of sedation protocols and daily sedation interruption: a multidisciplinary survey. J Crit Care 2008; 24:66-73. [PMID: 19272541 DOI: 10.1016/j.jcrc.2008.03.037] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 03/11/2008] [Accepted: 03/29/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although use of sedation protocols and daily sedation interruption (DSI) improve outcome, their current use and barriers affecting their use are unclear. METHODS We designed a multidisciplinary, Web-based survey to determine current use of sedation protocols and DSI and the perceived barriers to each, and administered it to members of the Society of Critical Care Medicine. RESULTS The 904 responders were physicians (60%), nurses (14%), or pharmacists (12%); 45% worked in a university hospital. Of 64% having a sedation protocol, 78% used it for >or=50% of ventilated patients. Reasons for lack of protocol use included no physician order (35%), lack of nursing support (11%), and a fear of oversedation (7%). Daily sedation interruption was used by only 40%. Barriers to DSI included lack of nursing acceptance (22%), concern about risk of patient-initiated device removal (19%), and inducement of either respiratory compromise (26%) or patient discomfort (13%). Clinicians who prefer propofol were more likely to use DSI than those who prefer benzodiazepines (55% vs 40, P < .0001). CONCLUSIONS Current intensive care unit sedation practices are heterogeneous, and the barriers preventing the use of both sedation protocols and DSI are numerous. These barriers should be addressed on an institutional basis to boost the use of these evidence-based practices.
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Affiliation(s)
- Maged A Tanios
- UCLA School of Medicine, St. Mary Medical Center, Long Beach, CA 90807, USA
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Ponsford J, Whelan-Goodinson R, Bahar-Fuchs A. Alcohol and drug use following traumatic brain injury: a prospective study. Brain Inj 2008; 21:1385-92. [PMID: 18066940 DOI: 10.1080/02699050701796960] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVES To establish pre-morbid alcohol and drug use in persons with TBI, relative to controls, investigate how patterns of substance use change over time following TBI and identify factors associated with heavy post-injury substance use. METHODS AND PROCEDURES The Alcohol Use Disorders Identification test (AUDIT) and Drug Abuse Screening Test (DAST) was completed by 121 hospital inpatients with TBI, documenting pre-injury alcohol and drug use, and 133 demographically similar controls. Participants with TBI completed these measures and the Hospital Anxiety and Depression Scale (HADS) again 1 and 2 years post-injury and 76 also completed them at 3 years. RESULTS Participants with TBI showed similar levels of drug and alcohol use to controls pre-injury, with 31.4% of the TBI group and 29.3% of controls drinking at hazardous levels. Alcohol and drug use declined in the first year post-injury, but increased by 2 years post-injury, with only 21.4% of participants with TBI reporting abstinence from alcohol and 25.4% drinking at hazardous levels. Only 9% showed a drug problem, but 24% had returned to some drug use. Those showing heavy alcohol use post-injury were young, male and heavy drinkers pre-injury. Drug and alcohol use was similar at 3 years post-injury. CONCLUSIONS More active intervention is needed to reduce alcohol and drug use following TBI.
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Affiliation(s)
- Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VA, Australia.
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Lange RT, Iverson GL, Franzen MD. Comparability of Neuropsychological Test Profiles in Patients with Chronic Substance Abuse and Mild Traumatic Brain Injury. Clin Neuropsychol 2008; 22:209-27. [PMID: 17853134 DOI: 10.1080/13854040701290062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to compare 104 patients with acute uncomplicated mild traumatic brain injury (MTBI) to a sample of 104 patients from an inpatient substance abuse program to determine whether these patients could be differentiated by their pattern of relative cognitive strengths and weaknesses. Patients were matched on age, education, and gender. Eight cognitive measures were used that included tests of attention, memory, and processing speed. There were no statistically significant differences between the two groups on any of the cognitive measures. Using a two-step cluster analysis procedure (i.e., hierarchical and k-means analyses), seven common profiles were identified. There was no significant difference in the proportions of patients from the MTBI or substance abuse group in each of the seven profiles. These results show that patients with uncomplicated MTBIs could not be reliably differentiated from patients with substance abuse problems on these cognitive measures. This is of particular concern for clinicians evaluating the neuropsychological effects of MTBI in individuals with a comorbid history of substance abuse.
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Affiliation(s)
- Rael T Lange
- British Columbia Mental Health and Addiction Services, Department of Research, Riverview Hospital, Coquitlam, British Columbia, Canada.
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Mainio A, Kyllönen T, Viilo K, Hakko H, Särkioja T, Räsänen P. Traumatic brain injury, psychiatric disorders and suicide: a population-based study of suicide victims during the years 1988-2004 in Northern Finland. Brain Inj 2008; 21:851-5. [PMID: 17676442 DOI: 10.1080/02699050701504265] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression and substance abuse are common among patients with traumatic brain injury (TBI). However, previous studies have not examined the temporal association between psychiatric disorders, TBI and suicide. OBJECTIVE To study the prevalence of TBI injury among suicide victims; to determine the association of suicide, psychiatric disorders and TBI severity; and to examine the effect of pre- and post-traumatic psychiatric disorders on their remaining life-time. METHODS This study examined all suicides (n = 1,877) committed during a 16-year period in the province of Oulu, Finland. The information of suicide victims was extracted from the official death certificates and the National Hospital Discharge Registers. RESULTS TBI was found in 5.5% (n = 103) of the victims. Compared to the victims without TBI, those with TBI had significantly more hospital-treated psychiatric and alcohol disorders. If TBI subjects had comorbid psychiatric disorders, the time period between TBI and suicide was under 3 years in approximately 90% of victims in this suicide population. CONCLUSIONS Seriousness of injury, male gender, older age, being unemployed and presence of psychiatric and alcohol disorders are important to identify as possible predictors for suicidal behaviour in TBI patients. Further studies are required to shed light on interventions aimed at better life management.
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Affiliation(s)
- Arja Mainio
- Department of Psychiatry, University of Oulu, Finland.
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Vickery CD, Sherer M, Nick TG, Nakase-Richardson R, Corrigan JD, Hammond F, Macciocchi S, Ripley DL, Sander A. Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury. Arch Phys Med Rehabil 2008; 89:48-55. [PMID: 18164330 DOI: 10.1016/j.apmr.2007.07.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 07/27/2007] [Accepted: 07/30/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the relationships among intoxication at time of injury, preinjury history of problem drinking, and early functional status in patients with traumatic brain injury (TBI). DESIGN Prospective cohort study. SETTING Acute inpatient TBI rehabilitation. PARTICIPANTS Participants were 1748 persons with TBI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Blood alcohol levels (BALs) were obtained at admission to the emergency department, and a history of problem drinking was obtained through interview. Study outcomes, Disability Rating Scale (DRS), and FIM instrument scores were gathered at admission to inpatient rehabilitation. RESULTS Multivariate regression analysis revealed that BAL and a history of binge drinking were predictive of DRS, but not FIM, scores. A higher BAL was associated with poorer functional status on the DRS. Paradoxically, a history of binge drinking was associated with more intact functional status on the DRS. CONCLUSIONS The relationships among intoxication at time of injury, history of problem drinking, and early outcome after TBI were modest. Injury severity had a more significant association with TBI functional status.
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Affiliation(s)
- Chad D Vickery
- Methodist Rehabilitation Center, Jackson, MS 39216, USA.
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