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Costello RS, Downing MG, Ponsford J. The experience of traumatic brain injury in a culturally and linguistically diverse sample in Australia. Disabil Rehabil 2024; 46:2069-2078. [PMID: 37237438 DOI: 10.1080/09638288.2023.2216473] [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] [Received: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE Individuals from culturally and linguistically diverse (CALD) backgrounds experience poorer outcomes following traumatic brain injury (TBI), including poorer quality of life. The reasons for these poorer outcomes are unclear. Therefore, this study aimed to qualitatively investigate the experience of injury, rehabilitation, and recovery amongst individuals from a CALD background following TBI. MATERIALS AND METHODS Fifteen semi-structured interviews were conducted, and qualitatively analysed using reflexive thematic analysis. RESULTS It was demonstrated that: (a) the cognitive and behavioural consequences of TBI were accompanied by stigma and loss of independence; (b) participants held many beliefs related to their TBI, ranging from bad luck to acceptance. Participants' personal values and beliefs provided strength and resilience, with many viewing the injury as a positive event in their lives; (c) participants were appreciative of the high standard of care they received in hospital and rehabilitation, although communication barriers were experienced; (d) many participants identified with Australian culture, and few believed their cultural background negatively impacted their experience of TBI; (e) external support, particularly from family, was considered central to recovery. CONCLUSION These findings offer insight into the challenges CALD individuals face and factors that may facilitate their recovery and improve functional outcomes.
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Affiliation(s)
- Reannon S Costello
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
| | - Marina G Downing
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
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LaBuzetta JN, Bongbong DN, Mlodzinski E, Sheth R, Trando A, Ibrahim N, Yip B, Malhotra A, Dinglas VD, Needham DM, Kamdar BB. Survivorship After Neurocritical Care: A Scoping Review of Outcomes Beyond Physical Status. Neurocrit Care 2024:10.1007/s12028-024-01965-9. [PMID: 38622487 DOI: 10.1007/s12028-024-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
Following intensive care unit hospitalization, survivors of acute neurological injury often experience debilitating short-term and long-term impairments. Although the physical/motor impairments experienced by survivors of acute neurological injury have been described extensively, fewer studies have examined cognitive, mental health, health-related quality of life (HRQoL), and employment outcomes. This scoping review describes the publication landscape beyond physical and/or motor sequelae in neurocritical care survivors. Databases were searched for terms related to critical illness, intensive care, and outcomes from January 1970 to March 2022. English-language studies of critically ill adults with a primary neurological diagnosis were included if they reported on at least one outcome of interest: cognition, mental health, HRQoL or employment. Data extraction was performed in duplicate for prespecified variables related to study outcomes. Of 16,036 abstracts screened, 74 citations were identified for inclusion. The studies encompassed seven worldwide regions and eight neurocritical diagnosis categories. Publications reporting outcomes of interest increased from 3 before the year 2000 to 71 after. Follow-up time points included ≤ 1 (n = 15 [20%] citations), 3 (n = 28 [38%]), 6 (n = 28 [38%]), and 12 (n = 21 [28%]) months and 1 to 5 (n = 19 [26%]) and > 5 years (n = 8 [11%]), with 28 (38%) citations evaluating outcomes at multiple time points. Sixty-six assessment tools were used to evaluate the four outcomes of interest: 22 evaluating HRQoL (56 [76%] citations), 21 evaluating cognition (20 [27%] citations), 21 evaluating mental health (18 [24%] citations), and 2 evaluating employment (9 [12%] citations). This scoping review aimed to better understand the literature landscape regarding nonphysical outcomes in survivors of neurocritical care. Although a rising number of publications highlight growing awareness, future efforts are needed to improve study consistency and comparability and characterize outcomes in a disease-specific manner, including outlining of a minimum core outcomes set and associated assessment tools.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA.
| | - Dale N Bongbong
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Eric Mlodzinski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Richa Sheth
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Aaron Trando
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Nicholas Ibrahim
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Brandon Yip
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
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Cai LT, Brett BL, Palacios EM, Yuh EL, Bourla I, Wren-Jarvis J, Wang Y, Mac Donald C, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Levin HS, Robertson CS, Temkin N, Markowitz AJ, Manley GT, Stein MB, McCrea MA, Zafonte RD, Nelson LD, Mukherjee P. Emotional Resilience Predicts Preserved White Matter Microstructure Following Mild Traumatic Brain Injury. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:164-175. [PMID: 36152948 PMCID: PMC10065831 DOI: 10.1016/j.bpsc.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adult patients with mild traumatic brain injury (mTBI) exhibit distinct phenotypes of emotional and cognitive functioning identified by latent profile analysis of clinical neuropsychological assessments. When discerned early after injury, these latent clinical profiles have been found to improve prediction of long-term outcomes from mTBI. The present study hypothesized that white matter (WM) microstructure is better preserved in an emotionally resilient mTBI phenotype compared with a neuropsychiatrically distressed mTBI phenotype. METHODS The present study used diffusion magnetic resonance imaging to investigate and compare WM microstructure in major association, projection, and commissural tracts between the two phenotypes and over time. Diffusion magnetic resonance images from 172 patients with mTBI were analyzed to compute individual diffusion tensor imaging maps at 2 weeks and 6 months after injury. RESULTS By comparing the diffusion tensor imaging parameters between the two phenotypes at global, regional, and voxel levels, emotionally resilient patients were shown to have higher axial diffusivity compared with neuropsychiatrically distressed patients early after mTBI. Longitudinal analysis revealed greater compromise of WM microstructure in neuropsychiatrically distressed patients, with greater decrease of global axial diffusivity and more widespread decrease of regional axial diffusivity during the first 6 months after injury compared with emotionally resilient patients. CONCLUSIONS These results provide neuroimaging evidence of WM microstructural differences underpinning mTBI phenotypes identified from neuropsychological assessments and show differing longitudinal trajectories of these biological effects. These findings suggest that diffusion magnetic resonance imaging can provide short- and long-term imaging biomarkers of resilience.
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Affiliation(s)
- Lanya T Cai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eva M Palacios
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christine Mac Donald
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Ramon Diaz-Arrastia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Harvey S Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Amy J Markowitz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Geoffrey T Manley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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Quang H, Wearne T, Filipcikova M, Pham N, Nguyen N, McDonald S. A Biopsychosocial Framework for Apathy Following Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09620-4. [PMID: 38112938 DOI: 10.1007/s11065-023-09620-4] [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: 11/22/2022] [Accepted: 09/19/2023] [Indexed: 12/21/2023]
Abstract
Apathy, the deficit of goal-directed behaviour, is well recognised as one of the most debilitating syndromes after moderate-to-severe traumatic brain injury (TBI). However, mechanisms underlying apathy, or at least factors associated with apathy, are sporadically reported. Based on a biopsychosocial framework, this systematic review and meta-analysis synthesised evidence regarding neurobiological, socio-environmental and individual factors associated with apathy. Our searches identified 21 studies satisfying inclusion and exclusion criteria. Results showed that the majority of work has focused on cognitive dysfunction, TBI-related factors, demographic variables and psychological correlates of apathy, while evidence for neural substrates and socio-cultural and premorbid aspects is scant. Overall, the current literature suggests that TBI-related and patient demographic factors did not contribute to apathy after TBI, whereas complex neurocognitive alterations, socio-environmental and cultural factors as well as patients' self-related factors may be important components. The evidence points to the multifaceted interplay of certain biopsychosocial contributors to apathy and suggests future investigations of more complex behavioural traits, cultural elements and pre-injury levels to better characterise the aetiology of this detrimental impairment after TBI.
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Affiliation(s)
- Halle Quang
- School of Health Sciences and Brain & Mind Centre, University of Sydney, Sydney, Australia.
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia.
| | | | - Michaela Filipcikova
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
| | - Nhi Pham
- School of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh City, Vietnam
| | - Nhi Nguyen
- Ho Chi Minh City University of Social Sciences and Humanities, Ho Chi Minh City, Vietnam
| | - Skye McDonald
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
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Mamman R, Grewal J, Garrone JN, Schmidt J. Biopsychosocial factors of quality of life in individuals with moderate to severe traumatic brain injury: a scoping review. Qual Life Res 2023:10.1007/s11136-023-03511-0. [PMID: 37925675 DOI: 10.1007/s11136-023-03511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Individuals with moderate to severe traumatic brain injury (TBI) experience changes in their quality-of-life (QOL) post-injury. Given the vast literature that exists about QOL after TBI, a scoping review was performed to identify the different biopsychosocial factors that affect a person's QOL after a moderate to severe TBI. METHODS A scoping review was conducted using the following electronic databases: MEDLINE, CINAHL, Embase, and PsycINFO. Terms relating to TBI and QOL were used. RESULTS There were 7576 articles obtained from the databases, resulting in 535 full-text articles. Ultimately, 52 articles were extracted, which consisted of biopsychosocial QOL factors after TBI. The biopsychosocial factors of QOL after TBI included 19 biological factors (i.e., sex, TBI severity, cognition), 16 psychological factors (i.e., depression, self-efficacy, coping styles), and 19 social factors (i.e., employment, social participation, social support). Factors such as fatigue, self-awareness, transition, and discharge from hospitals are known issues in TBI literature but were minimally reported in studies in this review, identifying them as potential gaps in research. CONCLUSION Identifying biopsychosocial factors relating to QOL after TBI can enable health services to develop targeted rehabilitation programs for individuals with TBI.
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Affiliation(s)
- Rinni Mamman
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Jasleen Grewal
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | | | - Julia Schmidt
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada.
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Torregrossa W, Raciti L, Rifici C, Rizzo G, Raciti G, Casella C, Naro A, Calabrò RS. Behavioral and Psychiatric Symptoms in Patients with Severe Traumatic Brain Injury: A Comprehensive Overview. Biomedicines 2023; 11:biomedicines11051449. [PMID: 37239120 DOI: 10.3390/biomedicines11051449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is defined as an altered brain structure or function produced by an external force. Adults surviving moderate and severe TBI often experience long-lasting neuropsychological and neuropsychiatric disorders (NPS). NPS can occur as primary psychiatric complications or could be an exacerbation of pre-existing compensated conditions. It has been shown that changes in behavior following moderate to severe TBI have a prevalence rate of 25-88%, depending on the methodology used by the different studies. Most of current literature has found that cognitive behavioral and emotional deficit following TBI occurs within the first six months whereas after 1-2 years the condition becomes stable. Identifying the risk factors for poor outcome is the first step to reduce the sequelae. Patients with TBI have an adjusted relative risk of developing any NPS several-fold higher than in the general population after six months of moderate-severe TBI. All NPS features of an individual's life, including social, working, and familiar relationships, may be affected by the injury, with negative consequences on quality of life. This overview aims to investigate the most frequent psychiatric, behavioral, and emotional symptoms in patients suffering from TBI as to improve the clinical practice and tailor a more specific rehabilitation training.
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Affiliation(s)
- William Torregrossa
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Loredana Raciti
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Carmela Rifici
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Giuseppina Rizzo
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Gianfranco Raciti
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Carmela Casella
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Antonino Naro
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
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7
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Li AD, Loi SM, Velakoulis D, Walterfang M. Mania Following Traumatic Brain Injury: A Systematic Review. J Neuropsychiatry Clin Neurosci 2023; 35:341-351. [PMID: 37021383 DOI: 10.1176/appi.neuropsych.20220105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. Mania is an uncommon, but debilitating, psychiatric occurrence following TBI. The literature on mania following TBI is largely limited to case reports and case series. In the present review, the investigators describe the clinical, diagnostic, and treatment characteristics of mania following TBI. METHODS A systematic search of MEDLINE, EMBASE, and PsycINFO was conducted for English-language studies published from 1980 to July 15, 2021. The included studies provided the required individual primary data and sufficient information on clinical presentation or treatment of manic symptoms. Studies with patients who reported a history of mania or bipolar disorder prior to TBI and studies with patients who sustained TBI before adulthood were excluded. RESULTS Forty-one studies were included, which reported information for 50 patients (the mean±SD age at mania onset was 39.1±14.3 years). Patients were more frequently male, aged <50 years, and without a personal or family history of psychiatric disorders. Although 74% of patients reported mania developing within 1 year following TBI, latencies of up to 31 years were observed. Illness trajectory varied from a single manic episode to recurrent mood episodes. Rapid cycling was reported in six patients. Mood stabilizers and antipsychotics were most frequently used to improve symptoms. CONCLUSIONS Heterogeneity of lesion locations and coexisting vulnerabilities make causality difficult to establish. Valproate or a second-generation antipsychotic, such as olanzapine or quetiapine, may be considered first-line therapy in the absence of high-level evidence for a more preferred treatment. Early escalation to combined therapy (mood stabilizer and second-generation antipsychotic) is recommended to control symptoms and prevent recurrence. Larger prospective studies and randomized controlled trials are needed to refine diagnostic criteria and provide definitive treatment recommendations.
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Affiliation(s)
- Anna D Li
- Melbourne Medical School (Li) and Department of Psychiatry (Loi, Velakoulis, Walterfang), University of Melbourne, Parkville, Australia; Department of Neuropsychiatry, Royal Melbourne Hospital, Parkville (all authors); Florey Institute for Neuroscience and Mental Health, Parkville (Walterfang)
| | - Samantha M Loi
- Melbourne Medical School (Li) and Department of Psychiatry (Loi, Velakoulis, Walterfang), University of Melbourne, Parkville, Australia; Department of Neuropsychiatry, Royal Melbourne Hospital, Parkville (all authors); Florey Institute for Neuroscience and Mental Health, Parkville (Walterfang)
| | - Dennis Velakoulis
- Melbourne Medical School (Li) and Department of Psychiatry (Loi, Velakoulis, Walterfang), University of Melbourne, Parkville, Australia; Department of Neuropsychiatry, Royal Melbourne Hospital, Parkville (all authors); Florey Institute for Neuroscience and Mental Health, Parkville (Walterfang)
| | - Mark Walterfang
- Melbourne Medical School (Li) and Department of Psychiatry (Loi, Velakoulis, Walterfang), University of Melbourne, Parkville, Australia; Department of Neuropsychiatry, Royal Melbourne Hospital, Parkville (all authors); Florey Institute for Neuroscience and Mental Health, Parkville (Walterfang)
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Hu X, Ou Y, Li J, Sun M, Ge Q, Pan Y, Cai Z, Tan R, Wang W, An J, Lu H. Voluntary Exercise to Reduce Anxiety Behaviour in Traumatic Brain Injury Shown to Alleviate Inflammatory Brain Response in Mice. Int J Mol Sci 2023; 24:ijms24076365. [PMID: 37047351 PMCID: PMC10093932 DOI: 10.3390/ijms24076365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
Traumatic brain injury is a leading cause of neuroinflammation and anxiety disorders in young adults. Immune-targeted therapies have garnered attention for the amelioration of TBI-induced anxiety. A previous study has indicated that voluntary exercise intervention following TBI could reduce neuroinflammation. It is essential to determine the effects of voluntary exercise after TBI on anxiety via inhibiting neuroinflammatory response. Mice were randomly divided into four groups (sham, TBI, sham + voluntary wheel running (VWR), and TBI + VWR). One-week VWR was carried out on the 2nd day after trauma. The neurofunction of TBI mice was assessed. Following VWR, anxiety behavior was evaluated, and neuroinflammatory responses in the perilesional cortex were investigated. Results showed that after one week of VWR, neurofunctional recovery was enhanced, while the anxiety behavior of TBI mice was significantly alleviated. The level of pro-inflammatory factors decreased, and the level of anti-inflammatory factors elevated. Activation of nucleotide oligomerization domain-like thermal receptor protein domain associated protein 3 (NLRP3) inflammasome was inhibited significantly. All these alterations were consistent with reduced microglial activation at the perilesional site and positively correlated with the amelioration of anxiety behavior. This suggested that timely rehabilitative exercise could be a useful therapeutic strategy for anxiety resulting from TBI by targeting neuroinflammation.
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Affiliation(s)
- Xiaoxuan Hu
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Department of Human Anatomy & Histoembryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yuhang Ou
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Jiashuo Li
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Meiqi Sun
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Qian Ge
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yongqi Pan
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Zhenlu Cai
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Ruolan Tan
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Department of Human Anatomy & Histoembryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Wenyu Wang
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Jing An
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Correspondence: (J.A.); (H.L.)
| | - Haixia Lu
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Correspondence: (J.A.); (H.L.)
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9
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Nguyen JVK, McKay A, Ponsford J, Davies K, Makdissi M, Drummond SPA, Reyes J, Willmott C. Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOveR): protocol of an investigator-blinded, randomised, case series with multiple baseline design to evaluate the feasibility and preliminary efficacy of a 12-week treatment for persistent post-concussion symptoms. Pilot Feasibility Stud 2022; 8:198. [PMID: 36064489 PMCID: PMC9441831 DOI: 10.1186/s40814-022-01153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Up to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored. METHODS Fifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews. DISCUSSION Results from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes. TRIAL REGISTRATION ANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118.
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Affiliation(s)
- Jack V K Nguyen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia
| | - Adam McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Katie Davies
- Neurological Rehabilitation Group, Melbourne, Australia
| | - Michael Makdissi
- Olympic Park Sports Medicine Centre, Melbourne, Australia.,Australian Football League, AFL House, 140 Harbour Esplanade, Docklands, Melbourne, VIC, 3008, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia
| | - Jonathan Reyes
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia.,Australian Football League, AFL House, 140 Harbour Esplanade, Docklands, Melbourne, VIC, 3008, Australia
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia. .,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia. .,Australian Football League, AFL House, 140 Harbour Esplanade, Docklands, Melbourne, VIC, 3008, Australia.
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10
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Boyko M, Gruenbaum BF, Shelef I, Zvenigorodsky V, Severynovska O, Binyamin Y, Knyazer B, Frenkel A, Frank D, Zlotnik A. Traumatic brain injury-induced submissive behavior in rats: link to depression and anxiety. Transl Psychiatry 2022; 12:239. [PMID: 35672289 PMCID: PMC9174479 DOI: 10.1038/s41398-022-01991-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Traumatic brain injury (TBI) affects millions of people worldwide, many of whom are affected with post-TBI mood disorders or behavioral changes, including aggression or social withdrawal. Diminished functionality can persist for decades after TBI and delay rehabilitation and resumption of employment. It has been established that there is a relationship between these mental disorders and brain injury. However, the etiology and causal relationships behind these conditions are poorly understood. Rodent models provide a helpful tool for researching mood disorders and social impairment due to their natural tendencies to form social hierarchies. Here, we present a rat model of mental complications after TBI using a suite of behavioral tests to examine the causal relationships between changes in social behavior, including aggressive, hierarchical, depressive, and anxious behavior. For this purpose, we used multivariate analysis to identify causal relationships between the above post-TBI psychiatric sequelae. We performed statistical analysis using principal component analysis, discriminant analysis, and correlation analysis, and built a model to predict dominant-submissive behavior based on the behavioral tests. This model displayed a predictive accuracy of 93.3% for determining dominant-submissive behavior in experimental groups. Machine learning algorithms determined that in rats, aggression is not a principal prognostic factor for dominant-submissive behavior. Alternatively, dominant-submissive behavior is determined solely by the rats' depressive-anxious state and exploratory activity. We expect the causal approach used in this study will guide future studies into mood conditions and behavioral changes following TBI.
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Affiliation(s)
- Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ilan Shelef
- Department of Radiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Vladislav Zvenigorodsky
- Department of Radiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Olena Severynovska
- Department of Biochemistry and Physiology of the Faculty of Biology and Ecology Oles Gonchar of the Dnipro National University, Dnipro, Ukraine
| | - Yair Binyamin
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Amit Frenkel
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dmitry Frank
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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11
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Li B, Fang Y, Lin J, Chen X, Li C, He M. Forensic psychiatric analysis of organic personality disorders after craniocerebral injury in Shanghai, China. Front Psychiatry 2022; 13:944888. [PMID: 35966473 PMCID: PMC9374033 DOI: 10.3389/fpsyt.2022.944888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore the incidence rate and the differences of clinical manifestations of organic personality disorders with varying degrees of craniocerebral trauma. MATERIALS AND METHODS According to the International Classification of Diseases-10, 1,027 subjects with craniocerebral trauma caused by traffic accidents were reviewed, the degrees of craniocerebral trauma were graded and those with personality disorder after craniocerebral trauma were diagnosed. The personality characteristics of all patients were evaluated by using the simplified Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI). RESULTS The incidence rate of organic personality disorder after all kinds of craniocerebral trauma was 33.1%, while it was 38.7 and 44.2% in the patients after moderate and severe craniocerebral trauma, respectively, which was significantly higher than that in the patients after mild craniocerebral trauma (18.0%) (P < 0.05). Compared with the patients without personality disorder, the neuroticism, extraversion and agreeableness scores all showed significantly differences (P < 0.05) in the patients with personality disorder after craniocerebral trauma; especially the conscientiousness scores showed significant differences (P < 0.05) in the patients with personality disorder after moderate and severe craniocerebral trauma. The agreeableness and conscientiousness scores in the patients with personality disorder after moderate and severe craniocerebral trauma were significantly lower than that after mild craniocerebral trauma, and the patients with personality disorder after severe craniocerebral trauma had lower scores in extraversion than that after mild craniocerebral trauma. CONCLUSION The severity and area of craniocerebral trauma is closely related to the incidence rate of organic personality disorder, and it also affects the clinical manifestations of the latter, which provides a certain significance and help for forensic psychiatric appraisal.
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Affiliation(s)
- Beixu Li
- School of Policing Studies, Shanghai University of Political Science and Law, Shanghai, China.,Shanghai Fenglin Forensic Center, Shanghai, China
| | - Youxin Fang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Junyi Lin
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Xueyan Chen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Chenhu Li
- Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Meng He
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
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12
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Falk H, Bechtold KT, Peters ME, Roy D, Rao V, Lavieri M, Sair H, Van Meter TE, Korley F. A Prognostic Model for Predicting One-Month Outcomes among Emergency Department Patients with Mild Traumatic Brain Injury and a Presenting Glasgow Coma Scale of Fifteen. J Neurotrauma 2021; 38:2714-2722. [PMID: 33957761 DOI: 10.1089/neu.2021.0137] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The lack of well-performing prognostic models for early prognostication of outcomes remains a major barrier to improving the clinical care of patients with mild traumatic brain injury (mTBI). We aimed to derive a prognostic model for predicting incomplete recovery at 1-month in emergency department (ED) patients with mTBI and a presenting Glasgow Coma Scale (GCS) score of 15 who were enrolled in the HeadSMART (Head Injury Serum Markers for Assessing Response to Trauma) study. The derivation cohort included 355 participants with complete baseline (day-of-injury) and follow-up data. The primary outcome measure was the Glasgow Outcome Scale Extended (GOSE) at 1-month and incomplete recovery was defined as a GOSE <8. At 1-month post-injury, incomplete recovery was present in 58% (n = 205) of participants. The final multi-variable logistic regression model included six variables: age in years (odds ratio [OR] = 0.98; 95% confidence interval [CI]: 0.97-1.00), positive head CT (OR = 4.42; 95% CI: 2.21-9.33), history of depression (OR = 2.59; 95% CI: 1.47-4.69), and self-report of moderate or severe headache (OR = 2.49; 95% CI: 1.49-4.18), difficulty concentrating (OR = 3.17; 95% CI: 1.53-7.04), and photophobia (OR = 4.17; 95% CI: 2.08-8.92) on the day-of-injury. The model was validated internally using bootstrap resampling (1000 resamples), which revealed a mean over-optimism value of 0.01 and an optimism-corrected area under the curve (AUC) of 0.79 (95% CI: 0.75-0.85). A prognostic model for predicting incomplete recovery among ED patients with mTBI and a presenting GCS of 15 using easily obtainable clinical and demographic variables has acceptable discriminative accuracy. External validation of this model is warranted.
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Affiliation(s)
- Hayley Falk
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen T Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mariel Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Haris Sair
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Frederick Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
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13
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Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study. Acta Neurochir (Wien) 2021; 163:2909-2917. [PMID: 34379205 PMCID: PMC8437905 DOI: 10.1007/s00701-021-04956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/26/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Psychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality. METHODS We conducted a retrospective multi-centre observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003-2013 that were alive at 1 year after injury. Patients were followed-up until end of 2016. We obtained data regarding psychotropic medication use through the national drug reimbursement database. We used multivariable logistic regression models to assess the association between TBI severity, treatment-related variables and the odds of psychotropic medication use and its association with late all-cause mortality (more than 1 year after TBI). RESULTS Of 3061 patients, 2305 (75%) were alive at 1 year. Of these, 400 (17%) became new psychotropic medication users. The most common medication types were antidepressants (61%), antipsychotics (35%) and anxiolytics (26%). A higher Glasgow Coma Scale (GCS) score was associated with lower odds (OR 0.93, 95% CI 0.90-0.96) and a diffuse injury with midline shift was associated with higher odds (OR 3.4, 95% CI 1.3-9.0) of new psychotropic medication use. After adjusting for injury severity, new psychotropic medication use was associated with increased odds of late mortality (OR 1.19, 95% CI 1.19-2.17, median follow-up time 6.4 years). CONCLUSIONS Psychotropic medication use is common in TBI survivors. Higher TBI severity is associated with increased odds of psychotropic medication use. New use of psychotropic medications after TBI was associated with increased odds of late mortality. Our results highlight the need for early identification of potential psychiatric sequelae and psychiatric evaluation in TBI survivors.
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14
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Afsar M, Shukla D, Bhaskarapillai B, Rajeswaran J. Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India. J Neurosci Rural Pract 2021; 12:295-301. [PMID: 33927520 PMCID: PMC8064862 DOI: 10.1055/s-0041-1722817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective
Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI.
Materials and Methods
The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention.
Statistical Analysis
Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test.
Results
The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved.
Conclusion
CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.
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Affiliation(s)
- Mohammed Afsar
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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15
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Forslund MV, Perrin PB, Sigurdardottir S, Howe EI, van Walsem MR, Arango-Lasprilla JC, Lu J, Aza A, Jerstad T, Røe C, Andelic N. Health-Related Quality of Life Trajectories across 10 Years after Moderate to Severe Traumatic Brain Injury in Norway. J Clin Med 2021; 10:jcm10010157. [PMID: 33466321 PMCID: PMC7794850 DOI: 10.3390/jcm10010157] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) has a long-lasting impact on participation and health-related quality of life (HRQL). We aimed to describe the physical and mental health trajectories and to identify their predictors across the first 10 years after TBI. A prospective longitudinal cohort of 97 individuals with moderate to severe TBI (age 16-55 years) in Norway were followed up at 1, 2, 5, and 10 years post-injury. Their socio-demographic and injury characteristics were recorded at baseline; their responses to the 36-Item Short Form Health Survey (SF-36) were collected at each follow-up. The Physical (PCS) and Mental Component Summary (MCS) scores were used as the outcome measures of physical and mental health. The predictors of the trajectories were described and examined using hierarchical linear modelling. The subscale scores showed a stable or increasing trend, but only the Role Physical and Role Emotional subscales showed clinically relevant positive changes from 1 to 10 years post-injury. Longer time, male gender, employment pre-injury, and shorter length of post-traumatic amnesia were significant predictors of better physical health trajectories; longer time, male gender, and employment pre-injury were significant predictors of better mental health trajectories. At-risk individuals may be targeted to receive rehabilitation interventions to improve their long-term quality of life outcomes.
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Affiliation(s)
- Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (E.I.H.); (C.R.); (N.A.)
- Correspondence:
| | - Paul B. Perrin
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23233, USA;
| | | | - Emilie I. Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Marleen R. van Walsem
- Department of Neurohabilitation, Oslo University Hospital, 0424 Oslo, Norway;
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE, Basque Foundation for Science, 48013 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA 23233, USA;
| | - Alba Aza
- Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain;
- Institute on Community Inclusion (INICO), University of Salamanca, 37005 Salamanca, Spain
| | - Tone Jerstad
- Department of Neuroradiology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (E.I.H.); (C.R.); (N.A.)
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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16
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Hicks AJ, Clay FJ, Hopwood M, James AC, Perry LA, Jayaram M, Batty R, Ponsford JL. Efficacy and Harms of Pharmacological Interventions for Anxiety after Traumatic Brain Injury: Systematic Review. J Neurotrauma 2020; 38:519-528. [PMID: 33045912 DOI: 10.1089/neu.2020.7277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
After a traumatic brain injury (TBI), many persons experience significant and debilitating problems with anxiety. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for anxiety after TBI. We reviewed studies published in English before July 2020 and included original research on pharmacological interventions for anxiety after TBI in adults ≥16 years of age. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in symptoms of anxiety and occurrence of harms. The secondary outcomes of interest were changes in depression, cognition, quality of life, and participation. Data were summarized in a narrative synthesis, and evidence quality was assessed using the Cochrane Risk of Bias tool. Only a single non-peer-reviewed, randomized controlled trial of 19 male military service members with mild TBI met inclusion criteria. This study found no significant effect of citalopram on anxiety symptoms over a 12-week intervention. The trial was stopped early because of poor recruitment, and much of the study detail was not included in the report. The methodological quality of the study was difficult to assess because of the lack of detail. No recommendations could be drawn from this review. There is a critical need for adequately powered and controlled studies of pharmacological interventions for anxiety after TBI across all severities that examine side-effect profiles and consider issues of comorbidity and effects of long-term pharmacotherapy.
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona J Clay
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Luke A Perry
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Batty
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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17
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Rowlands L, Coetzer R, Turnbull O. This time it's personal: reappraisal after acquired brain injury. Cogn Emot 2020; 35:305-323. [PMID: 33153409 DOI: 10.1080/02699931.2020.1839384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reappraisal is a widely investigated emotion regulation strategy, often impaired in those with acquired brain injury (ABI). Little is known, however, about the tools to measure this capacity in patients, who may find traditional reappraisal tasks difficult. Fifty-five participants with ABI, and thirty-five healthy controls (HCs), completed reappraisal tasks with personal and impersonal emotion elicitation components, questionnaires measuring reappraisal (the ERQ-CA), and neuropsychological assessment. The main findings demonstrated that both groups produced more reappraisals, and rated their reappraisal ideas as more effective for personal stimuli. The ABI group were significantly faster to generate reappraisals for personal, compared to impersonal, stimuli. Yet, participants with ABI performed worse than HCs on the majority of reappraisal components, across both reappraisal tasks. Results of regression analyses revealed significant relationships between certain measures of cognitive control and certain reappraisal components, which varied for the personal and impersonal reappraisal task. Notably, while inhibition predicted aspects of reappraisal in both the ABI and HC group, working memory was only related to reappraisal in participants with ABI. The study suggests that personal context plays a key role in reappraisal, and proposes a model to better understand the role of cognitive control across the reappraisal process.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
| | - Rudi Coetzer
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
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18
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von Steinbüchel N, Meeuwsen M, Zeldovich M, Vester JC, Maas A, Koskinen S, Covic A. Differences in Health-Related Quality of Life after Traumatic Brain Injury between Varying Patient Groups: Sensitivity of a Disease-Specific (QOLIBRI) and a Generic (SF-36) Instrument. J Neurotrauma 2020; 37:1242-1254. [PMID: 31801408 DOI: 10.1089/neu.2019.6627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Factors associated with health-related quality of life (HRQOL) in patients after traumatic brain injury (TBI) include severity of initial injury, different grades of trauma recovery, sociodemographic status, and psychological characteristics. Yet, sensitivity of HRQOL instruments to such effects is often underexplored. Thus, we aimed to compare the capacity of the disease-specific QOLIBRI (Quality of Life after Brain Injury) and the generic Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey(SF-36) to detect significant differences in HRQOL between patients. Patients (n = 795) completed HRQOL, sociodemographic, clinical, psychological, and health status questionnaires. Univariate (Wilcoxon-Mann-Whitney) and multi-variate (Wei-Lachin) non-parametric analyses were conducted using the Wilcoxon-Mann-Whitney approach to compare the sensitivity of the QOLIBRI and the SF-36. For both instruments, HRQOL was particularly influenced by patients' reliance on others, depression, anxiety, and recovery status, whereas smaller effects were found for living arrangements and participation in leisure activities. Both HRQOL instruments were sensitive to group differences, but the QOLIBRI was able to detect a greater number of and finer differences between specific patient groups, which is particularly important in clinical and therapeutic contexts. This finding is likely explained by the QOLIBRI's greater specificity to disease-specific aspects of consequences of TBI. This head-to-head HRQOL instrument comparison resulted in a recommendation for the use of the QOLIBRI when detailed insight in the subjective consequences and impact of TBI on patients is required.
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Affiliation(s)
- Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Mirjam Meeuwsen
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
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19
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Cannella LA, Andrews AM, Razmpour R, McGary H, Corbett CB, Kahn J, Ramirez SH. Reward and immune responses in adolescent females following experimental traumatic brain injury. Behav Brain Res 2019; 379:112333. [PMID: 31682867 DOI: 10.1016/j.bbr.2019.112333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
The pathology of traumatic brain injury (TBI) adversely affects many brain regions, often resulting in the development of comorbid psychiatric disorders including substance use disorders (SUD). Although traditionally thought to be an epidemic that predominantly affects males, recent clinical studies report females have higher rates of concussions and longer recovery times than males. Yet, how neurotrauma, particularly deep within the brain, between the sexes is differentially manifested remains largely unknown. The risk of TBI peaks during adolescence when neuronal networks that regulate reward behaviors are not fully developed. Previously, using the conditioned place preference (CPP) assay, we found that adolescent TBI increased susceptibility to the rewarding effects of cocaine in male mice. Further, we observed augmented inflammatory profiles, increased microglial phagocytosis of neuronal proteins, and decreased neuronal spine density in the NAc. Notably, the extent of sex differences in SUD susceptibility following TBI has not be investigated. Thus, here we ask the central question of whether the adolescent TBI-induced neuroinflammatory profile at reward centers is divergent in a sex-dependent manner. Using the CPP assay, we found that female mice with high levels of female sex hormones at the time of adolescent TBI demonstrated neuroprotection against increased sensitivity to the rewarding effects of cocaine. These studies also provide evidence of significantly reduced microglial activation and phagocytosis of neuronal proteins within the NAc of females. Overall, our results offer crucial insight into how adolescent TBI impacts the reward pathway in a sex depending manner that could explain a vulnerability to addiction-like behavior.
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Affiliation(s)
- Lee Anne Cannella
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Allison M Andrews
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Roshanak Razmpour
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Hannah McGary
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Cali B Corbett
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Jana Kahn
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Servio H Ramirez
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; Shriners Hospital for Pediatric Research Center, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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20
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Smith EE, Smith JAD, Juengst SB. Cognitive process scores associated with self-reported behavioral dysfunction on the Frontal Systems Behavior Scale (FrSBe) in chronic traumatic brain injury. J Clin Exp Neuropsychol 2019; 42:90-100. [DOI: 10.1080/13803395.2019.1676882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Emily E. Smith
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason A. D. Smith
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Abstract
This article discusses measuring quality of life (QOL) loss in litigation. Case examples are provided. The complexity challenge in QOL assessment is more easily addressed since the advent of computer adaptive testing, which is used by physicians and rehabilitationists in the administration of psychometric instruments to determine QOL loss. It is now possible to write algorithms to capture QOL data through text-mining. If QOL domains and their factors could be accessed through text-mining, it would make for an extraordinary opportunity for much needed doctoral level research in QOL issues for injured workers in workers' compensation programs.
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22
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Rowlands L, Coetzer R, Turnbull OH. Good things better? Reappraisal and discrete emotions in acquired brain injury. Neuropsychol Rehabil 2019; 30:1947-1975. [PMID: 31161878 DOI: 10.1080/09602011.2019.1620788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There has been substantial interest in emotion after acquired brain injury (ABI), but less attention paid to emotion regulation (ER). Research has focused primarily on the ER strategy of reappraisal for regulating negative emotions, without distinguishing between classes of emotion, and there has been no attempt at exploring these differences in patients with ABI. The present study explored components of reappraisal, across classes of emotion, and their associated neuropsychological mechanisms. Thirty-five patients with ABI and twenty-two matched healthy control participants (HCs) completed two questionnaires, a battery of cognitive tasks, and an emotion regulation task (the Affective Story Recall Reappraisal task). Results suggest that those with ABI take longer, and generate fewer reappraisals than HCs across several discrete emotions. Notably, their ability to decrease emotional intensity did not differ significantly to HCs for negative emotions, but findings suggest that their reappraisals are less effective when up-regulating neutral emotions to positive. Working memory was the only significant predictor of the total number of reappraisals generated, and the time taken to produce a first reappraisal. Implications of these findings are discussed in the context of neuropsychological rehabilitation, including the role of the relatives in implementing and reinforcing micro-interventions.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
| | - Rudi Coetzer
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
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23
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Voormolen DC, Polinder S, von Steinbuechel N, Vos PE, Cnossen MC, Haagsma JA. The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury 2019; 50:1068-1074. [PMID: 30554897 DOI: 10.1016/j.injury.2018.12.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
A subset of mild traumatic brain injury (mTBI) patients experience post-concussion symptoms. When a cluster of post-concussion symptoms persists for over three months, it is referred to as post-concussion syndrome (PCS). Little is known about the association between PCS and Health-Related Quality of Life (HRQoL) after mTBI. The aims of this study were to assess the implications of PCS on HRQoL six months after mTBI and the relationship between PCS and HRQoL domains. A prospective observational cohort study was conducted among a sample of mTBI patients. Follow-up postal questionnaires at six months after emergency department (ED) admission included socio-demographic information, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and HRQoL measured with the 36-item Short-Form Health Survey (SF-36) and the Perceived Quality of Life Scale (PQoL). In total, 731 mTBI patients were included, of whom 38.7% were classified as suffering from PCS. Patients with PCS had significantly lower scores on all SF-36 domains, lower physical and mental component summary scores and lower mean PQoL scores compared to patients without PCS. All items of the RPQ were negatively correlated to all SF-36 domains and PQoL subscale scores, indicating that reporting problems on any of the RPQ symptoms was associated with a decrease on different aspects of an individuals' HRQoL. To conclude, PCS is common following mTBI and patients with PCS have a considerably lower HRQoL. A better understanding of the relationship between PCS and HRQoL and possible mediating factors in this relationship could improve intervention strategies, the recovery process for mTBI patients and benchmarking.
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Affiliation(s)
- Daphne C Voormolen
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University, Göttingen, Germany.
| | - Pieter E Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands.
| | - Maryse C Cnossen
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands; Department of Emergency Medicine, Erasmus University Medical Center Rotterdam, the Netherlands.
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24
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Areas FZ, Schwarzbold ML, Diaz AP, Rodrigues IK, Sousa DS, Ferreira CL, Quevedo J, Lin K, Kupek E, Ritter C, Dal Pizzol F, Walz R. Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil. Front Neurol 2019; 10:432. [PMID: 31105642 PMCID: PMC6494964 DOI: 10.3389/fneur.2019.00432] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/09/2019] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male (n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% (n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.
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Affiliation(s)
- Fernando Zanela Areas
- Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil.,Programa de Pós-Graduação em Neurociências, UFSC, Florianópolis, Brazil
| | - Marcelo Liborio Schwarzbold
- Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil.,Programa de Pós-Graduação em Neurociências, UFSC, Florianópolis, Brazil.,Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Serviço de Psiquiatria, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Alexandre Paim Diaz
- Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil.,Serviço de Psiquiatria, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Igor Kunze Rodrigues
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Serviço de Neurocirurgia, HU, UFSC, Florianópolis, Brazil.,Serviço de Neurocirurgia, Hospital Regional de São José Homero de Miranda Gomes, São José, Brazil
| | - Daniel Santos Sousa
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Serviço de Neurocirurgia, Hospital Governado Celso Ramos, Florianópolis, Brazil
| | - Camila Leite Ferreira
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
| | - João Quevedo
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil.,Department of Psychiatry and Behavioral Sciences McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Katia Lin
- Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil.,Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Emil Kupek
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Departmento de Saúde Pública, UFSC, Florianópolis, Brazil
| | - Cristiane Ritter
- Hospital São José, Criciúma, Brazil.,Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, UNESC, Criciúma, Brazil
| | - Felipe Dal Pizzol
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Hospital São José, Criciúma, Brazil.,Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, UNESC, Criciúma, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil.,Programa de Pós-Graduação em Neurociências, UFSC, Florianópolis, Brazil.,Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
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25
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Mitrushina M, Tomaszewski R. The effect of subjective perception of cognition on emotional functioning in adults with long-term neurological and neuropsychiatric disorders. Disabil Rehabil 2019; 42:3135-3141. [PMID: 31006289 DOI: 10.1080/09638288.2019.1585490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To examine effects of subjective perception and objective status of cognition on emotional functioning in a sample of adults with long-term neurological and neuropsychiatric disorders.Method: N = 65. Subjective measures were derived from the self-ratings on the Problem Checklist (PCL) from the HI-FI; the objective status was represented by combined externally standardised scores on neuropsychological tests across three cognitive domains: verbal memory, executive functioning, and psychomotor speed.Results: No relationship was found between self-ratings of cognitive competence and performance on neuropsychological tests. Based on the results of the multiple regression analysis, approximately 40% of the variability in emotional functioning was explained by self-perceived cognitive and physical competence, while the addition of objective measures of cognition increased predictive capacity by only 1.3%. The awareness scores were calculated as the difference between objective performance scores and self-ratings of cognition. Overall, the sample demonstrated a tendency towards low awareness of cognitive deficits. Patients who overestimated cognitive deficits self-rated emotional functioning at a significantly lower level, while those with average or low awareness of deficits were equally emotionally content.Conclusions: Self-perception of competence, rather than objective level of functioning influence emotional well-being and quality of life in individuals with long-term disabilities in our study.IMPLICATIONS FOR REHABILITATIONCognitive deficits are common consequences of neurological dysfunction.This study shows that self-perception of cognitive competence, rather than objective level of cognitive functioning has critical influence on emotional well-being and perceived quality of life.An addition of psychotherapeutic intervention directed at alleviation of self-perception bias is likely to improve emotional well-being and enhance efficiency of rehabilitation efforts in patients with long-term disabilities due to neurological disorders.Based on our findings, patients with long-term disabilities could benefit from psychotherapy to improve their self-perception and quality of life.
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Affiliation(s)
- Maura Mitrushina
- Department of Psychology, California State University, Northridge, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Robert Tomaszewski
- Department of Psychology, California State University, Northridge, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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26
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Polich G, Iaccarino MA, Zafonte R. Psychopharmacology of traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:253-267. [PMID: 31727216 DOI: 10.1016/b978-0-444-64012-3.00015-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The pathophysiology of traumatic brain injury (TBI) can be highly variable, involving functional and/or structural damage to multiple neuroanatomical networks and neurotransmitter systems. This wide-ranging potential for physiologic injury is reflected in the diversity of neurobehavioral and neurocognitive symptoms following TBI. Here, we aim to provide a succinct, clinically relevant, up-to-date review on psychopharmacology for the most common sequelae of TBI in the postacute to chronic period. Specifically, treatment for neurobehavioral symptoms (depression, mania, anxiety, agitation/irritability, psychosis, pseudobulbar affect, and apathy) and neurocognitive symptoms (processing speed, attention, memory, executive dysfunction) will be discussed. Treatment recommendations will reflect general clinical practice patterns and the research literature.
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Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.
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27
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A Network Pharmacology Analysis to Explore the Effect of Astragali Radix-Radix Angelica Sinensis on Traumatic Brain Injury. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3951783. [PMID: 30596090 PMCID: PMC6286735 DOI: 10.1155/2018/3951783] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 12/23/2022]
Abstract
Traumatic brain injury (TBI) is a critical public health and socioeconomic problem worldwide. The herb pair Astragali Radix (AR)-Radix Angelica Sinensis (RAS) is a common prescribed herbal formula or is added to other Chinese medicine prescriptions for traumatic brain injury (TBI) treatment. However, the underlying mechanisms are unclear. In this study, we aimed to explore the active ingredients and action targets of AR-RAS based on the combined methods of network pharmacology prediction and experimental verification. Furthermore, the corresponding potential mechanisms of “multicomponents, multitargets, and multipathways” were disclosed. Methods. A network pharmacology approach including ADME (absorption, distribution, metabolism, and excretion) filter analysis, target prediction, known therapeutic targets collection, Gene Ontology (GO), pathway enrichment analysis, and network construction was used in this study. Further verification experiments were performed to reveal the therapeutic effects of AR-RAS in a rat model of TBI. Results. The comprehensive systematic approach was to successfully identify 14 bioactive ingredients in AR-RAS, while 33 potential targets hit by these ingredients related to TBI. Based on GO annotation analysis, multiple biological processes were significantly regulated by AR-RAS. In addition, 89 novel signaling pathways (P<0.05) underlying the effects of AR-RAS for TBI treatment were identified by DAVID. The neurotrophin signaling pathway was suggested as the major related pathway targeted by AR-RAS to improve axonal growth. The animal experiment confirmed that AR-RAS significantly induced tissue recovery and improved neurological deficits on the 14th day (P<0.01). Treatment with AR-RAS markedly reduced the protein and mRNA expression level of NogoA in the hippocampus of TBI rats. Conclusion. Our work illuminates the “multicompounds, multitargets, and multipathways” curative action of AR-RAS in the treatment of TBI by network pharmacology. The animal experiment verifies the effects of AR-RAS on neurological function improvement and axonal outgrowth via downregulation of NogoA expression, providing a theoretical basis for further research on treatment of TBI.
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28
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Disability in amyotrophic lateral sclerosis compared with traumatic brain injury using the World Health Organization Disability Assessment Schedule 2.0 and the International Classification of Functioning minimal generic set. Int J Rehabil Res 2018; 41:224-229. [PMID: 30095553 DOI: 10.1097/mrr.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We compared the functioning of two neurological patient groups, amyotrophic lateral sclerosis (ALS) and traumatic brain injury (TBI), using brief and validated International Classification of Functioning (ICF)-based tools. A 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was mailed to ALS and TBI patients and their significant others 2 weeks before their appointment at an outpatient clinic of a university hospital. In addition, a neurologist filled in the ICF minimal generic set. Two years after diagnosis, no significant differences between the two diagnosis groups were found in overall functioning or in working ability using either patient or proxy WHODAS or physician-rated minimal generic set. In single items, however, clear differences were found. Patients and significant others rated household activities, mobility, and self-care as more impaired in the group with ALS, and learning, concentrating, and maintaining friendships in the group with TBI. There were no differences between the two diagnosis groups in the WHODAS items emotional functions, engaging in community, relating with strangers, or in working ability. Both brief ICF-based generic scales, WHODAS and the ICF generic set, could show differences between these patient groups with severe disability. The results of this study should promote assessment of disability with WHODAS 2.0 in ALS and TBI.
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29
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Feasibility and Preliminary Validation of an Online Version of the Ohio State University Traumatic Brain Injury Identification Method. Arch Phys Med Rehabil 2018; 99:1811-1817. [PMID: 29709522 DOI: 10.1016/j.apmr.2018.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/12/2018] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI). DESIGN Cross-sectional. SETTING General community. PARTICIPANTS A volunteer sample of individuals (N= 265) from the general population across the United States. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Online version of the Ohio State University Traumatic Brain Injury Identification Method, Rivermead Postconcussion Symptoms Questionnaire (RPQ), Patient-Reported Outcomes Measurement Information System Cognitive Concerns Scale. RESULTS The measure was completed by 89.4% of the sample with most participants completing the measure in <8 minutes. After controlling for age, sex, psychiatric history, drug or alcohol history, and history of developmental disability, worst TBI severity was significantly associated with scores on the RPQ, F(2,230)=4.56, P=.011, and having a TBI within the past 2 years was associated with higher scores on the cognitive factor subscale of the RPQ, F(1,75)=7.7, P=.007. CONCLUSIONS The online administration of the Ohio State University Traumatic Brain Injury Identification Method appears to be feasible in the general population. Preliminary validity was demonstrated for the indices of worst TBI severity and time since most recent TBI.
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30
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Grauwmeijer E, Heijenbrok-Kal MH, Peppel LD, Hartjes CJ, Haitsma IK, de Koning I, Ribbers GM. Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study. J Neurotrauma 2018; 35:1543-1551. [PMID: 29343203 DOI: 10.1089/neu.2017.5404] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18-67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.
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Affiliation(s)
- Erik Grauwmeijer
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Lianne D Peppel
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | | | - Iain K Haitsma
- 3 Department of Neurosurgery, Erasmus University Medical Center , Rotterdam, The Netherlands
| | | | - Gerard M Ribbers
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
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31
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Verberne DPJ, Spauwen PJJ, van Heugten CM. Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review. Neuropsychol Rehabil 2018; 29:1509-1542. [DOI: 10.1080/09602011.2018.1433049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daan P. J. Verberne
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Peggy J. J. Spauwen
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Ilie G, Adlaf EM, Mann RE, Ialomiteanu A, Hamilton H, Rehm J, Asbridge M, Cusimano MD. Associations between self-reported lifetime history of traumatic brain injuries and current disability assessment in a population sample of Canadian adults. PLoS One 2018; 13:e0188908. [PMID: 29304117 PMCID: PMC5755742 DOI: 10.1371/journal.pone.0188908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study describes the association between history of lifetime traumatic brain injury (TBI) and current disabling functional restrictions among Ontario adults. SETTING AND DESIGN A two-stage rolling cross-sectional sample of 6,048 adults aged 18 to 93 were interviewed by computer assisted telephone interviewing between 2011-2013 regarding their mental health and substance use in Ontario, Canada. TBI criteria were defined by loss of consciousness for minimum five minutes or at least one overnight hospitalization. Dimensions of functionality restrictions in the last 30 days were measured with the WHO Disability Assessment Schedule (WHODAS). RESULTS The estimated mean for global disability in this sample of Ontario adults was 2.75 (SD = 5.4, range 0-40). The estimated means of global disability for individuals who reported a history of lifetime TBI was 4.16 (SD = 7.12) and compared with 2.46 (SD = 4.98) for individuals who never had a TBI (p < 0.001). Adults with a history of lifetime TBI had greater odds of global and item disability including restricted cognition, decreased self-care, difficulties with social relationships, fewer life activities and reduced participation in society compared to adults without a history of TBI (p < 0.001), even after adjusting for values of age, sex, marital status, household income and education. CONCLUSION The co-occurrence of history of lifetime TBI with self-reported disability within the past 30 days provide evidence that careful consideration, planning and understanding of short and long term health needs of TBI survivors are critical.
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Affiliation(s)
- Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Edward M. Adlaf
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robert E. Mann
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anca Ialomiteanu
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hayley Hamilton
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jürgen Rehm
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Michael D. Cusimano
- Injury Prevention Research Office, St. Michael’s Hospital, Toronto, Canada
- Division of Neurosurgery, University of Toronto, Toronto, Canada
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Hohl A, Zanela FA, Ghisi G, Ronsoni MF, Diaz AP, Schwarzbold ML, Dafre AL, Reddi B, Lin K, Pizzol FD, Walz R. Luteinizing Hormone and Testosterone Levels during Acute Phase of Severe Traumatic Brain Injury: Prognostic Implications for Adult Male Patients. Front Endocrinol (Lausanne) 2018; 9:29. [PMID: 29487565 PMCID: PMC5816813 DOI: 10.3389/fendo.2018.00029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/22/2018] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is a worldwide core public health problem affecting mostly young male subjects. An alarming increase in incidence has turned TBI into a leading cause of morbidity and mortality in young adults as well as a tremendous resource burden on the health and welfare sector. Hormone dysfunction is highly prevalent during the acute phase of severe TBI. In particular, investigation of the luteinizing hormone (LH) and testosterone levels during the acute phase of severe TBI in male has identified a high incidence of low testosterone levels in male patients (36.5-100%) but the prognostic significance of which remains controversial. Two independent studies showed that normal or elevated levels of LH levels earlier during hospitalization are significantly associated with higher mortality/morbidity. The association between LH levels and prognosis was independent of other predictive variables such as neuroimaging, admission Glasgow coma scale, and pupillary reaction. The possible mechanisms underlying this association and further research directions in this field are discussed. Overall, current data suggest that LH levels during the acute phase of TBI might contribute to accurate prognostication and further prospective multicentric studies are required to develop more sophisticated predictive models incorporating biomarkers such as LH in the quest for accurate outcome prediction following TBI. Moreover, the potential therapeutic benefits of modulating LH during the acute phase of TBI warrant investigation.
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Affiliation(s)
- Alexandre Hohl
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Fernando Areas Zanela
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Gabriela Ghisi
- Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Fernando Ronsoni
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Alexandre Paim Diaz
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Psiquiatria, Departamento de Clínica Médica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Liborio Schwarzbold
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Psiquiatria, Departamento de Clínica Médica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Alcir Luiz Dafre
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Departamento de Bioquímica, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Benjamin Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Kátia Lin
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Felipe Dal Pizzol
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Laboratório de Fisiopatologia Experimental, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- *Correspondence: Roger Walz,
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Weber KT, Guimarães VA, Pontes Neto OM, Leite JP, Takayanagui OM, Santos-Pontelli TEG. Predictors of quality of life after moderate to severe traumatic brain injury. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:409-15. [PMID: 27191238 DOI: 10.1590/0004-282x20160053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/15/2016] [Indexed: 11/21/2022]
Abstract
Objective To verify correlations between age, injury severity, length of stay (LOS), cognition, functional capacity and quality of life (QOL) six months after hospital discharge (HD) of victims of traumatic brain injury (TBI). Method 50 patients consecutively treated in a Brazilian emergency hospital were assessed at admission, HD and six months after HD. The assessment protocol consisted in Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Mini Mental Test, Barthel Index and World Health Organization QOL - Brief. Results Strong negative correlation was observed between LOS and GCS and LOS and RTS. An almost maximal correlation was found between RTS and GCS and functional capacity and GCS at HD. Age and LOS were considered independent predictors of QOL. Conclusion Age and LOS are independent predictors of QOL after moderate to severe TBI.
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Affiliation(s)
- Karina Tavares Weber
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Viviane Assunção Guimarães
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Octávio M Pontes Neto
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - João P Leite
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Osvaldo Massaiti Takayanagui
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Taiza E G Santos-Pontelli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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von Steinbüchel N, Real RGL, Sasse N, Wilson L, Otto C, Mullins R, Behr R, Deinsberger W, Martinez-Olivera R, Puschendorf W, Petereit W, Rohde V, Schmidt H, Sehmisch S, Stürmer KM, von Wild K, Gibbons H. German validation of Quality of Life after Brain Injury (QOLIBRI) assessment and associated factors. PLoS One 2017; 12:e0176668. [PMID: 28542226 PMCID: PMC5443488 DOI: 10.1371/journal.pone.0176668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/12/2017] [Indexed: 01/07/2023] Open
Abstract
The consequences of traumatic brain injury (TBI) for health-related quality of life (HRQoL) are still poorly understood, and no TBI-specific instrument has hitherto been available. This paper describes in detail the psychometrics and validity of the German version of an internationally developed, self-rated HRQoL tool after TBI-the QOLIBRI (Quality of Life after Brain Injury). Factors associated with HRQoL, such as the impact of cognitive status and awareness, are specifically reported. One-hundred seventy-two participants after TBI were recruited from the records of acute clinics, most of whom having a Glasgow Coma Scale (GCS) 24-hour worst score and a Glasgow Outcome Scale (GOSE) score. Participants had severe (24%), moderate (11%) and mild (56%) injuries as assessed on the GCS, 3 months to 15 years post-injury. The QOLIBRI uses 37 items to measure "satisfaction" in the areas of "Cognition", "Self", "Daily Life and Autonomy", and "Social Relationships", and "feeling bothered" by "Emotions"and "Physical Problems". The scales meet standard psychometric criteria (α = .84 to .96; intra-class correlation-ICC = .72 to .91). ICCs (0.68 to 0.90) and αs (.83 to .96) were also good in a subgroup of participants with lower cognitive performance. The six-subscale structure of the international sample was reproduced for the German version using confirmatory factor analyses and Rasch analysis. Scale validity was supported by systematic relationships observed between the QOLIBRI and the GOSE, Patient Competency Rating Scale for Neurorehabilitation (PCRS-NR), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Short Form 36 (SF-36), and Satisfaction with Life Scale (SWLS). The German QOLIBRI contains novel information not provided by other currently available measures and has good psychometric criteria. It is potentially useful for clinicians and researchers, in post-acute and rehabilitation studies, on a group and individual level.
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Affiliation(s)
- Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Ruben G. L. Real
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Nadine Sasse
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Lindsay Wilson
- Department of Psychology, University of Stirling, Stirling, United Kingdom
| | - Christiane Otto
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Ryan Mullins
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Robert Behr
- Department of Neurosurgery, Clinical Center Fulda, Fulda, Germany
| | | | - Ramon Martinez-Olivera
- Department of Neurosurgery & Neurotraumatology at Bergmannsheil University Hospital Bochum, Bochum, Germany
| | | | - Werner Petereit
- Department of Neurosurgery, Clinical Center Bernburg, Bernburg, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Holger Schmidt
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Stephan Sehmisch
- Trauma surgery, plastic and reconstructive surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Klaus Michael Stürmer
- Trauma surgery, plastic and reconstructive surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Henning Gibbons
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Department of Psychology, University of Bonn, Bonn, Germany
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Cnossen MC, Polinder S, Vos PE, Lingsma HF, Steyerberg EW, Sun Y, Ye P, Duan L, Haagsma JA. Comparing health-related quality of life of Dutch and Chinese patients with traumatic brain injury: do cultural differences play a role? Health Qual Life Outcomes 2017; 15:72. [PMID: 28410593 PMCID: PMC5391570 DOI: 10.1186/s12955-017-0641-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/27/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is growing interest in health related quality of life (HRQoL) as an outcome measure in international trials. However, there might be differences in the conceptualization of HRQoL across different socio-cultural groups. The objectives of current study were: (I) to compare HRQoL, measured with the short form (SF)-36 of Dutch and Chinese traumatic brain injury (TBI) patients 1 year after injury and; (II) to assess whether differences in SF-36 profiles could be explained by cultural differences in HRQoL conceptualization. TBI patients are of particular interest because this is an important cause of diverse impairments and disabilities in functional, physical, emotional, cognitive, and social domains that may drastically reduce HRQoL. METHODS A prospective cohort study on adult TBI patients in the Netherlands (RUBICS) and a retrospective cohort study in China were used to compare HRQoL 1 year post-injury. Differences on subscales were assessed with the Mann-Whitney U-test. The internal consistency, interscale correlations, item-internal consistency and item-discriminate validity of Dutch and Chinese SF-36 profiles were examined. Confirmatory factor analysis was performed to assess whether Dutch and Chinese data fitted the SF-36 two factor-model (physical and mental construct). RESULTS Four hundred forty seven Dutch and 173 Chinese TBI patients were included. Dutch patients obtained significantly higher scores on role limitations due to emotional problems (p < .001) and general health (p < .001), while Chinese patients obtained significantly higher scores on physical functioning (p < .001) and bodily pain (p = .001). Scores on these subscales were not explained by cultural differences in conceptualization, since item- and scale statistics were all sufficient. However, differences among Dutch and Chinese patients were found in the conceptualization of the domains vitality, mental health and social functioning. CONCLUSIONS One year after TBI, Dutch and Chinese patients reported a different pattern of HRQoL. Further, there might be cultural differences in the conceptualization of some of the SF-36 subscales, which has implications for outcome evaluation in multi-national trials.
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Affiliation(s)
- Maryse C Cnossen
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Suzanne Polinder
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Pieter E Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Yanming Sun
- Beijing Centers for Disease Control and Prevention, Beijng, People's Republic of China
| | - Pengpeng Ye
- NCDC, China CDC, Beijing, People's Republic of China
| | - Leilei Duan
- NCDC, China CDC, Beijing, People's Republic of China.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Juanita A Haagsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Jones M, Acion L, Jorge RE. What are the complications and emerging strategies for preventing depression following traumatic brain injury? Expert Rev Neurother 2017; 17:631-640. [PMID: 28343407 DOI: 10.1080/14737175.2017.1311788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Depression is a common and disabling complication of traumatic brain injury (TBI). The high rates of post-TBI depression (PTBID) make this condition an important candidate for selective preventive interventions. Areas covered: The authors recently reported on the efficacy of sertraline, a selective serotonin reuptake inhibitor (SSRI), for the prevention of new cases of depression in the first six months after TBI. The authors review this and other studies on preventive strategies in PTBID as ascertained from a PubMed and citation search. The potential complications and barriers to the implementation of pharmacological prevention in patients with TBI are also discussed. Expert commentary: The prevention of depression in patients with TBI has received little attention relative to other medical conditions. Future studies are needed to confirm the benefit of SSRIs and investigate other pharmacological and non-pharmacological interventions, including in special groups of patients at greater risk of developing PTBID.
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Affiliation(s)
- Melissa Jones
- a VA South Central Mental Illness Research , Education and Clinical Center , Houston , TX , USA.,b Mental Health Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,d Beth K. and Stuart C. Yudofsky Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
| | - Laura Acion
- c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,e Iowa Consortium for Substance Abuse Research and Evaluation , University of Iowa , Iowa , IA , USA
| | - Ricardo E Jorge
- b Mental Health Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,d Beth K. and Stuart C. Yudofsky Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
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Avramović P, Kenny B, Power E, McDonald S, Tate R, Hunt L, MacDonald S, Heard R, Togher L. Exploring the relationship between cognition and functional verbal reasoning in adults with severe traumatic brain injury at six months post injury. Brain Inj 2017; 31:502-516. [DOI: 10.1080/02699052.2017.1280854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Petra Avramović
- Discipline of Speech Pathology, The University of Sydney, Sydney, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
| | - Emma Power
- Discipline of Speech Pathology, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of NSW, Sydney, Australia
| | - Robyn Tate
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Louise Hunt
- Discipline of Speech Pathology, The University of Sydney, Sydney, Australia
| | | | - Rob Heard
- Discipline of Speech Pathology, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
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Brandel MG, Hirshman BR, McCutcheon BA, Tringale K, Carroll K, Richtand NM, Perry W, Chen CC, Carter BS. The Association between Psychiatric Comorbidities and Outcomes for Inpatients with Traumatic Brain Injury. J Neurotrauma 2016; 34:1005-1016. [PMID: 27573722 DOI: 10.1089/neu.2016.4504] [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: 01/02/2023] Open
Abstract
It is well established that traumatic brain injury (TBI) is associated with the development of psychiatric disorders. However, the impact of psychiatric disorders on TBI outcome is less well understood. We examined the outcomes of patients who experienced a traumatic subdural hemorrhage and whether a comorbid psychiatric disorder was associated with a change in outcome. A retrospective observational study was performed in the California Office of Statewide Health Planning and Development (OSHPD) and the Nationwide Inpatient Sample (NIS). Patients hospitalized for acute subdural hemorrhage were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Patients with coexisting psychiatric diagnoses were identified. Outcomes studied included mortality and adverse discharge disposition. In OSPHD, diagnoses of depression (OR = 0.64, p < 0.001), bipolar disorder (OR = 0.45, p < 0.05), and anxiety (OR = 0.37, p < 0.001) were associated with reduced mortality during hospitalization for TBI, with a trend toward psychosis (OR = 0.56, p = 0.08). Schizophrenia had no effect. Diagnoses of psychosis (OR = 2.12, p < 0.001) and schizophrenia (OR = 2.60, p < 0.001) were associated with increased adverse discharge. Depression and bipolar disorder had no effect, and anxiety was associated with reduced adverse discharge (OR = 0.73, p = 0.01). Results were confirmed using the NIS. Analysis revealed novel associations between coexisting psychiatric diagnoses and TBI outcomes, with some subgroups having decreased mortality and increased adverse discharge. Potential mechanisms include pharmacological effects of frequently prescribed psychiatric medications, the pathophysiology of individual psychiatric disorders, or under-coding of psychiatric illness in the most severely injured patients. Because pharmacological mechanisms, if validated, might lead to improved outcome in TBI patients, further studies may provide significant public health benefit.
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Affiliation(s)
- Michael G Brandel
- 1 School of Medicine, University of California San Diego , La Jolla, California
| | - Brian R Hirshman
- 1 School of Medicine, University of California San Diego , La Jolla, California.,2 School of Computer Science, Carnegie Mellon University , Pittsburgh, Pennsylvania
| | - Brandon A McCutcheon
- 3 Department of Neurologic Surgery, Mayo Clinic and Mayo Clinic Foundation , Rochester, Minnesota
| | - Kathryn Tringale
- 1 School of Medicine, University of California San Diego , La Jolla, California
| | - Kate Carroll
- 1 School of Medicine, University of California San Diego , La Jolla, California
| | - Neil M Richtand
- 4 Department of Psychiatry, University of California San Diego , San Diego, California.,5 Psychiatry Service, VA San Diego Healthcare System , San Diego, California
| | - William Perry
- 4 Department of Psychiatry, University of California San Diego , San Diego, California
| | - Clark C Chen
- 6 Department of Neurosurgery, University of California San Diego , La Jolla, California
| | - Bob S Carter
- 6 Department of Neurosurgery, University of California San Diego , La Jolla, California
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Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2016; 33:1969-1994. [PMID: 26729611 DOI: 10.1089/neu.2015.4252] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review examined pre- and post-injury prevalence of, and risk factors for, anxiety disorders and depressive disorders after traumatic brain injury (TBI), based on evidence from structured diagnostic interviews. A systematic literature search was conducted in EMBASE, MEDLINE, Cochrane Central, PubMed, PsycINFO, and Google Scholar. We identified studies in civilian adults with TBI reporting on the prevalence of anxiety and depressive disorders using structured diagnostic interviews and assessed their quality. Pooled pre- and post-injury prevalence estimates of anxiety disorders and depressive disorders were computed. A total of 34 studies described in 68 publications were identified, often assessing anxiety disorders (n = 9), depressive disorders (n = 7), or a combination of disorders (n = 6). Prevalence rates of psychiatric disorders varied widely. Pooled prevalence estimates of anxiety and depressive disorders were 19% and 13% before TBI and 21% and 17% in the first year after TBI. Pooled prevalence estimates increased over time and indicated high long-term prevalence of Axis I disorders (54%), including anxiety disorders (36%) or depressive disorders (43%). Females, those without employment, and those with a psychiatric history before TBI were at higher risk for anxiety and depressive disorders after TBI. We conclude that a substantial number of patients encounter anxiety and depressive disorders after TBI, and that these problems persist over time. All health care settings should pay attention to the occurrence of psychiatric symptoms in the aftermath of TBI to enable early identification and treatment of these disorders and to enhance the recovery and quality of life of TBI survivors.
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Affiliation(s)
- Annemieke C Scholten
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Juanita A Haagsma
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Maryse C Cnossen
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Miranda Olff
- 2 Department of Psychiatry, Center for Psychological Trauma, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Ed F van Beeck
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Suzanne Polinder
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
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Moreno-López L, Sahakian BJ, Manktelow A, Menon DK, Stamatakis EA. Depression following traumatic brain injury: A functional connectivity perspective. Brain Inj 2016; 30:1319-1328. [DOI: 10.1080/02699052.2016.1186839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Barbara J. Sahakian
- Department of Psychiatry, MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Anne Manktelow
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - David K. Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
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Alway Y, Gould KR, McKay A, Johnston L, Ponsford J. The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury. J Neurotrauma 2016; 33:825-31. [DOI: 10.1089/neu.2015.3992] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Yvette Alway
- School of Psychological Sciences, Monash University, Melbourne Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Kate Rachel Gould
- School of Psychological Sciences, Monash University, Melbourne Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Monash University, Melbourne Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Lisa Johnston
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
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Khajavikhan J, Vasigh A, Kokhazade T, Khani A. Association between Hyperglycaemia with Neurological Outcomes Following Severe Head Trauma. J Clin Diagn Res 2016; 10:PC11-3. [PMID: 27190880 DOI: 10.7860/jcdr/2016/17208.7686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/09/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Head Trauma (HT) is a major cause of death, disability and important public health problem. HT is also the main cause of hyperglycaemia that can increase mortality. AIM The aim of this study was to assess the correlation between hyperglycaemia with neurological outcomes following severe Traumatic Brain Injury (TBI). MATERIALS AND METHODS This is a descriptive and correlation study that was carried out at the Imam Khomeini Hospital affiliated with Ilam University of Medical Sciences, Ilam, IR, during March 2014-March 2015 on patients with severe TBI. Data were collected from the patient records on mortality, Intensive Care Unit (ICU) length of stay, hospital length of stay, admission GCS score, Injury Severity Score (ISS), mechanical ventilation, Ventilation Associated Pneumonia (VAP) and Acute Respiratory Distress Syndrome (ARDS). Random Blood Sugar (RBS) level on admission was recorded. Patients with diabetes mellitus (to minimize the overlap between acute stress hyperglycaemia and diabetic hyperglycaemia) were excluded. RESULTS About 34(40%) of patients were admitted with hyperglycaemia (RBS ≥ 200 mg/dl) over the study period. The mortality rate, length of ICU stay, hospital stay, ISS and VAP & ARDS in patients with RBS levels ≥ 200 mg was significantly higher than patients with RBS levels below ≤ 200mg (p<0.05, p<0.001). A significant correlation was found between RBS with GCS arrival, length of ICU stay, length of hospital stay, ISS, mechanical ventilation and VAP & ARDS (p<0.05, p< 0.001). RBS is a predicate factor for ISS (p <0.05, OR : 1.36), GCS (p <0.001, OR : 1.69), mechanical ventilation (p< 0.05, OR : 1.27), VAP & ARDS (p <0.001, OR : 1.68), length of ICU stay (p <0.001, OR : 1.87) and length of hospital stay (p <0.05, OR : 1.24). CONCLUSION Hyperglycaemia after severe TBI (RBS ≥ 200) is associated with poor outcome. It can be a predictive factor for mortality rate, ICU stay, GCS arrival, VAP & RDS, hospital stay and ISS. Management of hyperglycaemia with insulin protocol in cases with value >200mg/dl, is critical in improving the outcome of patients with TBI.
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Affiliation(s)
- Javaher Khajavikhan
- Anaesthesiologist, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Aminolah Vasigh
- Anaesthesiologist, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Taleb Kokhazade
- Student, Department of Nursing, Nursing & Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Ali Khani
- Student, Department of Nursing, Nursing & Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
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Alway Y, Gould KR, Johnston L, McKenzie D, Ponsford J. A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury. Psychol Med 2016; 46:1331-1341. [PMID: 26867715 DOI: 10.1017/s0033291715002986] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. METHOD Participants were 161 individuals (78.3% male) with moderate (31.2%) or severe (68.8%) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. RESULTS In the first 5 years post-injury, 75.2% received a psychiatric diagnosis, commonly emerging within the first year (77.7%). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5%) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6% over time, decreasing by 27% [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65-0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95% CI 0.63-0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95% CI 1.41-4.25) and accident-related limb injury (OR 1.78, 95% CI 1.03-3.07). CONCLUSIONS Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders.
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Affiliation(s)
- Y Alway
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
| | - K R Gould
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
| | - L Johnston
- Monash-Epworth Rehabilitation Research Centre,Epworth Hospital,Melbourne,Australia
| | - D McKenzie
- Research Development and Governance,Epworth Healthcare,Melbourne,Australia
| | - J Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
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Leonhardt A, Schmukle SC, Exner C. Evidence of Big-Five personality changes following acquired brain injury from a prospective longitudinal investigation. J Psychosom Res 2016; 82:17-23. [PMID: 26944394 DOI: 10.1016/j.jpsychores.2016.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/22/2015] [Accepted: 01/13/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Many studies using different assessment methods have reported personality changes after acquired brain injury (ABI). However, to our knowledge, no prospective study has yet been conducted to examine whether previous cross-sectional and retrospective results can be replicated in a longitudinal prospective design. Further, because clinical control groups were only rarely used, it remains debatable if the personality changes found are unique to patients with ABI or if they also affect patients with other disabilities. METHODS This study examined personality change in 114 participants with different kinds of ABI, 1321 matched controls (general control, GC), and 746 matched participants with restrictive impairments other than brain injury (clinical control, CC) in a prospective longitudinal design using data from the panel survey Household, Income and Labour Dynamics in Australia (HILDA). RESULTS Participants with ABI showed significantly larger declines in Extraversion and Conscientiousness compared with the GC group. When the ABI participants were compared with the CC group, only the difference in Conscientiousness remained significant. CONCLUSION Our prospective data corroborate evidence from previous cross-sectional studies that patients with ABI experience larger declines in Extraversion and Conscientiousness than the general population. Whereas the effect on Conscientiousness was unique to patients with ABI, the decline in Extraversion was also observed in participants with other impairments.
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Affiliation(s)
- Anne Leonhardt
- Department of Psychology, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany.
| | - Stefan C Schmukle
- Department of Psychology, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany
| | - Cornelia Exner
- Department of Psychology, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany
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Khajavikhan J, Vasigh A, Khani A, Jaafarpour M, Kokhazade T. Outcome and Predicting Factor Following Severe Traumatic Brain Injury: A Retrospective Cross-Sectional Study. J Clin Diagn Res 2016; 10:PC16-9. [PMID: 27042518 DOI: 10.7860/jcdr/2016/16390.7294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Severe traumatic brain injury (TBI) is a major and challenging problem in critical care medicine. AIM To assess the outcome and predicting factor following severe TBI. MATERIALS AND METHODS This is a retrospective and cross-sectional study. Data were collected from two sections; one section consisting of a questionnaire answered by the patients and other section from the patient records. The instruments used included the Glasgow Outcome Scale (GOS), SF-36 and the Hospital Anxiety and Depression Scale (HAD). RESULTS The mortality rate of the patients was 46.2%. The quality of life (QOL) of the patients in most dimension were impaired and (58%) of patients had unfavourable QOL. About (37.5%) of patients with anxiety and (27.5%) had a depression. A significant correlation was found between age, GCS arrival, length of ICU stay, mechanical ventilation, VAP & ARDS and pupil reactivity with QOL, GOS, HAD-A and HAD-D (p<0.05, p< 0.001). GCS arrival a predicate factor for QOL and GOS (p <0.001, OR: 1.75, 1.94 respectively); length of ICU stay a predicate factor for QOL and GOS (p <0.05, OR : 1.11, 1.28 respectively); mechanical ventilation a predicate factor for GOS (p <0.001, OR : 1.78); ventilation associated pneumonia (VAP) & acute respiratory distress syndrome (ARDS) and pupil reactivity a predicate factor for GOS (p <0.05, OR : 1.36; p<0.001, OR: 1.94 respectively). The GCS arrival and ICU stay a predicate factor for HAD-A (p<0.05, OR: 1.73, 1.38 respectively). CONCLUSION With respect to results advanced in pre hospital, medical and surgical care for the decrease in mortality rates of Head trauma (HT), the use of trauma triage tools and strict enforcement of traffic rules are necessary.
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Affiliation(s)
- Javaher Khajavikhan
- Anaesthesiologist, Department of Anesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Aminolah Vasigh
- Anaesthesiologist, Department of Anesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Ali Khani
- MSc of Nursing, Department of Nursing, Nursing and Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Molouk Jaafarpour
- MSc of Midwifery, Department of Midwifery, Nursing and Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Taleb Kokhazade
- MSc of Nursing, Department of Nursing, Nursing and Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
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Assessment of Health-Related Quality of Life after TBI: Comparison of a Disease-Specific (QOLIBRI) with a Generic (SF-36) Instrument. Behav Neurol 2016; 2016:7928014. [PMID: 27022207 PMCID: PMC4753323 DOI: 10.1155/2016/7928014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/26/2015] [Accepted: 11/04/2015] [Indexed: 11/17/2022] Open
Abstract
Psychosocial, emotional, and physical problems can emerge after traumatic brain injury (TBI), potentially impacting health-related quality of life (HRQoL). Until now, however, neither the discriminatory power of disease-specific (QOLIBRI) and generic (SF-36) HRQoL nor their correlates have been compared in detail. These aspects as well as some psychometric item characteristics were studied in a sample of 795 TBI survivors. The Shannon H (') index absolute informativity, as an indicator of an instrument's power to differentiate between individuals within a specific group or health state, was investigated. Psychometric performance of the two instruments was predominantly good, generally higher, and more homogenous for the QOLIBRI than for the SF-36 subscales. Notably, the SF-36 "Role Physical," "Role Emotional," and "Social Functioning" subscales showed less satisfactory discriminatory power than all other dimensions or the sum scores of both instruments. The absolute informativity of disease-specific as well as generic HRQoL instruments concerning the different groups defined by different correlates differed significantly. When the focus is on how a certain subscale or sum score differentiates between individuals in one specific dimension/health state, the QOLIBRI can be recommended as the preferable instrument.
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Janzen EP, Walz R, Lin K. Cross-cultural adaptation of the SCATBI instrument for cognitive-linguistic abilities after traumatic brain injury. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:939-45. [PMID: 26517218 DOI: 10.1590/0004-282x20150146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To perform the cross-cultural adaptation of the "Scales of Cognitive Ability for Traumatic Brain Injury" (SCATBI). METHOD After the translation and back-translation phases, a multidisciplinary committee judged and elaborated versions in order to maintain its conceptual equivalence, content, comprehensibility and contextual adjustment for Brazilian population. The final version was tested on 55 healthy subjects. RESULTS The individuals' mean age was 41.75 ± 17.40 years (range = 18-81), 69% were women and they had a mean schooling of 12.96 ± 4.55 years. Higher total scores were positively correlated with years of schooling (p < 0.001) and social-economic status (p = 0.001), while older aged individuals performed worse than younger ones (p = 0.001). Both genders performed similarly on all domains of the instrument, except for "organization" ability, where women performed significantly better than men (p = 0.02). CONCLUSION The Brazilian version of SCATBI is a useful tool for the diagnosis and monitoring of cognitive impairments after a traumatic brain injury.
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Affiliation(s)
- Ester Priscila Janzen
- Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Katia Lin
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Abstract
In addition to the well-known cognitive impairment following traumatic brain injury (TBI), neuropsychiatric sequelae are often reported as well. Although not the most common neuropsychiatric consequence of TBI, obsessive-compulsive disorder (OCD) has been associated with TBI. However, diagnosing new onset OCD secondary to TBI is complicated by the potential for cognitive impairment secondary to TBI masquerading as OCD. In particular, memory difficulties and executive dysfunction may be confused as representing obsessions and compulsions. Research in this area, which could guide clinical practice, remains limited. In addition to using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria, neuropsychological testing and collateral interviews may help clinicians when considering differential diagnoses in this complex area of neuropsychiatry.
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