1
|
Li CY, Chuang CC, Chen CC, Tu PH, Hsu TA, Kuo YC, Liao CH, Hsieh CH, Fu CY. Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT. World J Surg 2022; 46:2882-9. [PMID: 36131183 DOI: 10.1007/s00268-022-06747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients' characteristics. METHODS From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score < 13, negative CT scan and normal laboratory test results] were evaluated. Patients who regained consciousness were analyzed. Multivariate logistic regression (MLR) analyses were used to evaluate independent factors for regaining consciousness. RESULTS A total of 77 patients were included in this study. Fifty-eight (75.3%) patients regained consciousness, most within one day (43.1%). Nineteen (24.7%) patients never regained consciousness. MLR analysis showed that initial GCS score (odds 1.85, p = 0.017), early airway protection in ED (odds 25.02, p = 0.018) and 72-h GCS score improvement by two points (odds 0.02, p = 0.001) were independent factors for regaining consciousness. Overall, 94.1% of patients who received early airway protection and improved 2 points in 72-h GCS score regained consciousness. The association between days to M5 status and days to M6 status (consciousness) was highly significant. Fewer days to M5 status were highly associated with needing fewer days to regain consciousness. CONCLUSIONS For TBI patients with unconsciousness and normal initial head CT, a higher probability of regaining consciousness was observed in those who underwent early airway protection and who improved 2 points in 72-h GCS score. Regaining consciousness within a short period could be expected in patients with M5 status.
Collapse
|
2
|
Hergert DC, Sicard V, Stephenson DD, Pabbathi Reddy S, Robertson-Benta CR, Dodd AB, Bedrick EJ, Gioia GA, Meier TB, Shaff NA, Quinn DK, Campbell RA, Phillips JP, Vakhtin AA, Sapien RE, Mayer AR. Test-Retest Reliability of a Semi-Structured Interview to Aid in Pediatric Traumatic Brain Injury Diagnosis. J Int Neuropsychol Soc 2022; 28:687-99. [PMID: 34376268 DOI: 10.1017/S1355617721000928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Retrospective self-report is typically used for diagnosing previous pediatric traumatic brain injury (TBI). A new semi-structured interview instrument (New Mexico Assessment of Pediatric TBI; NewMAP TBI) investigated test-retest reliability for TBI characteristics in both the TBI that qualified for study inclusion and for lifetime history of TBI. METHOD One-hundred and eight-four mTBI (aged 8-18), 156 matched healthy controls (HC), and their parents completed the NewMAP TBI within 11 days (subacute; SA) and 4 months (early chronic; EC) of injury, with a subset returning at 1 year (late chronic; LC). RESULTS The test-retest reliability of common TBI characteristics [loss of consciousness (LOC), post-traumatic amnesia (PTA), retrograde amnesia, confusion/disorientation] and post-concussion symptoms (PCS) were examined across study visits. Aside from PTA, binary reporting (present/absent) for all TBI characteristics exhibited acceptable (≥0.60) test-retest reliability for both Qualifying and Remote TBIs across all three visits. In contrast, reliability for continuous data (exact duration) was generally unacceptable, with LOC and PCS meeting acceptable criteria at only half of the assessments. Transforming continuous self-report ratings into discrete categories based on injury severity resulted in acceptable reliability. Reliability was not strongly affected by the parent completing the NewMAP TBI. CONCLUSIONS Categorical reporting of TBI characteristics in children and adolescents can aid clinicians in retrospectively obtaining reliable estimates of TBI severity up to a year post-injury. However, test-retest reliability is strongly impacted by the initial data distribution, selected statistical methods, and potentially by patient difficulty in distinguishing among conceptually similar medical concepts (i.e., PTA vs. confusion).
Collapse
|
3
|
Jensen SM, Abrahamsen I, Baumgarten M, Gallaher J, Feltner C. Screening tools for predicting posttraumatic stress disorder in acutely injured adult trauma patients: A systematic review. J Trauma Acute Care Surg 2022; 92:e115-26. [PMID: 34991124 DOI: 10.1097/TA.0000000000003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adult trauma patients are at risk of developing posttraumatic stress disorder (PTSD). Early intervention reduces the development of PTSD, but few trauma patients seek and obtain care. Valid and reliable screening tools are needed to identify patients at risk of developing PTSD. The objective of this review is to identify existing screening tools and evaluate their accuracy for predicting PTSD outcomes. METHODS PubMed, PsychInfo, and ClinicalTrials.gov were searched for studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians. Eligible studies assessed patients during acute hospitalization and at least 1 month following injury to measure PTSD outcome. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following the Agency for Healthcare Research and Quality guidelines. RESULTS Forty-nine studies were included evaluating the predictive accuracy of 38 screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen, Posttraumatic Adjustment Screen, the PTSD Checklist for DSM-5, and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75-100%) and specificity (67-94%). Common sources of bias were selection bias due to high attrition rate and using nondiagnostic tools to assess PTSD symptoms at follow-up. CONCLUSION Although sensitivity and specificity of PTSD predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for screening programs and future intervention studies. LEVEL OF EVIDENCE Systematic review, level III.
Collapse
|
4
|
Stubbs JL, Thornton AE, Gicas KM, O'Connor TA, Livingston EM, Lu HY, Mehta AK, Lang DJ, Vertinsky AT, Field TS, Heran MK, Leonova O, Sahota CS, Buchanan T, Barr AM, MacEwan GW, Rauscher A, Honer WG, Panenka WJ. Characterizing Traumatic Brain Injury and Its Association with Losing Stable Housing in a Community-based Sample. Can J Psychiatry 2022; 67:207-215. [PMID: 33719613 PMCID: PMC8935598 DOI: 10.1177/07067437211000665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is increasingly recognized as a common and impactful health determinant in homeless and precariously housed populations. We sought to describe the history of TBI in a precariously housed sample and evaluate how TBI was associated with the initial loss and lifetime duration of homelessness and precarious housing. METHOD We characterized the prevalence, mechanisms, and sex difference of lifetime TBI in a precariously housed sample. We also examined the impact of TBI severity and timing on becoming and staying homeless or precariously housed; 285 precariously housed participants completed the Brain Injury Screening Questionnaire in addition to other health assessments. RESULTS A history of TBI was reported in 82.1% of the sample, with 64.6% reporting > 1 TBI, and 21.4% reporting a moderate or severe TBI. Assault was the most common mechanism of injury overall, and females reported significantly more traumatic brain injuries due to physical abuse than males (adjusted OR = 1.26, 95% CI = 1.14 to 1.39, P < 0.0001). The first moderate or severe TBI was significantly closer to the first experience of homelessness (b = 2.79, P = 0.003) and precarious housing (b = 2.69, P < 0.0001) than was the first mild TBI. In participants who received their first TBI prior to becoming homeless or precariously housed, traumatic brain injuries more proximal to the initial loss of stable housing were associated with a longer lifetime duration of homelessness (RR = 1.04, 95% CI = 1.02 to 1.06, P < 0.0001) and precarious housing (RR = 1.03, 95% CI = 1.01 to 1.04, P < 0.0001). CONCLUSIONS These findings demonstrate the high prevalence of TBI in this vulnerable population, and that aspects of TBI severity and timing are associated with the loss and lifetime duration of stable housing.
Collapse
Affiliation(s)
- Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Tiffany A O'Connor
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Emily M Livingston
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Henri Y Lu
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amiti K Mehta
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra T Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj K Heran
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charanveer S Sahota
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Lippa SM, French LM, Brickell TA, Driscoll AE, Glazer ME, Tippett CE, Sullivan JK, Lange RT. Post-Traumatic Stress Disorder Symptoms Are Related to Cognition after Complicated Mild and Moderate Traumatic Brain Injury but Not Severe and Penetrating Traumatic Brain Injury. J Neurotrauma 2021; 38:3137-3145. [PMID: 34409857 DOI: 10.1089/neu.2021.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although post-traumatic stress disorder (PTSD) has been associated with worse cognitive outcomes after mild traumatic brain injury (TBI), its impact has not been evaluated after more severe TBI. This study aimed to determine whether PTSD symptoms are related to cognition after complicated mild, moderate, severe, and penetrating TBI. Service members (n = 137) with a history of complicated mild/moderate TBI (n = 64) or severe/penetrating TBI (n = 73) were prospectively enrolled from United States Military Treatment Facilities. Participants completed a neuropsychological assessment one year or more post-injury. Six neuropsychological composite scores and an overall test battery mean (OTBM) were considered. Participants were excluded if there was evidence of invalid responding. Hierarchical linear regressions were conducted evaluating neuropsychological performance. The interaction between TBI severity and PTSD Checklist-Civilian version total score was significant for processing speed (β = 0.208, p = 0.034) and delayed memory (β = 0.239, p = 0.021) and trended toward significance for immediate memory (β = 0.190, p = 0.057) and the OTBM (β = 0.181, p = 0.063). For each of these composite scores, the relationship between PTSD symptoms and cognition was stronger in the complicated mild/moderate TBI group than the severe/penetrating TBI group. Within the severe/penetrating TBI group, PTSD symptoms were unrelated to cognitive performance. In contrast, within the complicated mild/moderate TBI group, PTSD symptoms were significantly related to processing speed (R2Δ = 0.077, β = -0.280, p = 0.019), immediate memory (R2Δ = 0.197, β = -0.448, p < 0.001), delayed memory (R2Δ = 0.176, β = -0.423, p < 0.001), executive functioning (R2Δ = 0.100, β = -0.317, p = 0.008), and the OTBM (R2Δ = 0.162, β = -0.405, p < 0.001). The potential impact of PTSD symptoms on cognition, over and above the impact of brain injury alone, should be considered with service members and veterans with a history of complicated mild/moderate TBI. In addition, in research comparing cognitive outcomes between patients with histories of complicated-mild, moderate, severe, and/or penetrating TBI, it will be important to account for PTSD symptoms.
Collapse
Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracey A Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA.,Centre of Excellence on Post-traumatic Stress Disorder, Ottawa, ON, Canada
| | - Angela E Driscoll
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Megan E Glazer
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Corie E Tippett
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Jamie K Sullivan
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA.,University of British Columbia, Vancouver, British Columbia, Canada.,Centre of Excellence on Post-traumatic Stress Disorder, Ottawa, ON, Canada
| |
Collapse
|
6
|
Pieper J, Chang DG, Mahasin SZ, Swan AR, Quinto AA, Nichols S, Diwakar M, Huang C, Swan J, Lee R, Baker DG, Huang M. Brain Amygdala Volume Increases in Veterans and Active-Duty Military Personnel With Combat-Related Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E1-E9. [PMID: 31033749 PMCID: PMC6814512 DOI: 10.1097/htr.0000000000000492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify amygdalar volumetric differences associated with posttraumatic stress disorder (PTSD) in individuals with comorbid mild traumatic brain injury (mTBI) compared with those with mTBI-only and to examine the effects of intracranial volume (ICV) on amygdala volumetric measures. SETTING Marine Corps Base and VA Healthcare System. PARTICIPANTS A cohort of veterans and active-duty military personnel with combat-related mTBI (N = 89). DESIGN Twenty-nine participants were identified with comorbid PTSD and mTBI. The remaining 60 formed the mTBI-only control group. Structural images of brains were obtained with a 1.5-T MRI scanner using a T1-weighted 3D-IR-FSPGR pulse sequence. Automatic segmentation was performed in Freesurfer. MAIN MEASURES Amygdala volumes with/without normalizations to ICV. RESULTS The comorbid mTBI/PTSD group had significantly larger amygdala volumes, when normalized to ICV, compared with the mTBI-only group. The right and left amygdala volumes after normalization to ICV were 0.122% ± 0.012% and 0.118% ± 0.011%, respectively, in the comorbid group compared with 0.115% ± 0.012% and 0.112% ± 0.009%, respectively, in the mTBI-only group (corrected P < .05). CONCLUSIONS The ICV normalization analysis performed here may resolve previous literature discrepancies. This is an intriguing structural finding, given the role of the amygdala in the challenging neuroemotive symptoms witnessed in casualties of combat-related mTBI and PTSD.
Collapse
Affiliation(s)
- Joel Pieper
- Department of Internal Medicine, University of California, San Diego, CA, USA
| | - Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | | | - Ashley Robb Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Mithun Diwakar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Charles Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - James Swan
- Department of Management Information Systems, San Diego State University, San Diego, CA, USA
| | - Roland Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G. Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Mingxiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| |
Collapse
|
7
|
Willaert W, Leysen L, Lenoir D, Meeus M, Cagnie B, Nijs J, Sterling M, Coppieters I. Combining Stress Management With Pain Neuroscience Education and Exercise Therapy in People With Whiplash-Associated Disorders: A Clinical Perspective. Phys Ther 2021; 101:6184954. [PMID: 33764474 DOI: 10.1093/ptj/pzab105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 02/28/2021] [Indexed: 11/12/2022]
Abstract
Individuals classified as having whiplash-associated disorder (WAD) grade II, which reflects approximately 93% of people with WAD who are commonly managed by health care professionals, exhibit both physical (eg, pain and disability) and psychological (eg, fear of movement, anxiety, posttraumatic stress) problems that, in approximately 50% of cases, persist beyond 3 months. There is still much ongoing debate regarding factors predictive of poor recovery. The strongest associations have been found for high initial pain and disability following whiplash injury. In addition, a growing body of evidence supports the clinical importance of characteristic features, such as disturbed nociceptive processing (eg, local or general hyperalgesia to cold and mechanical stimuli), inefficient cognitions and beliefs about pain/movement/recovery, and posttraumatic stress symptoms, in the development and maintenance of physical and psychological manifestations in individuals with WAD. For this reason, the field shifted away from single interventions that mainly follow a biomedical approach, such as exercise therapy and activity programs, to gold standard multimodal care (at least 2 distinct therapeutic modalities given by 1 or more health care professionals) that acknowledges the biopsychological nature of WAD. To date, there exist several multimodal care approaches to managing WAD; however, for most, the efficacy has been found to be rather limited. One may argue that the limited success of some approaches can be attributed to the fact that they focused mainly on rehabilitating the physical symptoms (eg, pain, disability) rather than also the associated cognitive (eg, catastrophizing) and psychological (eg, posttraumatic stress symptoms) symptoms of the condition, leaving much room for improvement. In this article, current and previous evidence is used to explain why and how a comprehensive and multimodal treatment for people with WAD-consisting of a combination of pain neuroscience education, cognition-targeted exercise therapy, and stress management-can be applied in clinical practice.
Collapse
Affiliation(s)
- Ward Willaert
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Laurence Leysen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Dorine Lenoir
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Michele Sterling
- Recover Injury Research Centre and NHMRC CRE in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, Australia
| | - Iris Coppieters
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| |
Collapse
|
8
|
Izzy S, Tahir Z, Grashow R, Cote DJ, Jarrah AA, Dhand A, Taylor H, Whalen M, Nathan DM, Miller KK, Speizer F, Baggish A, Weisskopf MG, Zafonte R. Concussion and Risk of Chronic Medical and Behavioral Health Comorbidities. J Neurotrauma 2021; 38:1834-1841. [PMID: 33451255 DOI: 10.1089/neu.2020.7484] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
While chronic neurological effects from concussion have been studied widely, little is known about possible links between concussion and long-term medical and behavioral comorbidities. We performed a retrospective cohort study of 9205 adult patients with concussion, matched to non-concussion controls from a hospital-based electronic medical registry. Patients with comorbidities before the index visit were excluded. Behavioral and medical comorbidities were defined by International Classification of Diseases, Ninth and Tenth Revision codes. Groups were followed for up to 10 years to identify comorbidity incidence after a concussion. Cox proportional hazards models were used to calculate associations between concussion and comorbidities after multi-variable adjustment. Patients with concussion were 57% male (median age: 31; interquartile range [IQR] = 23-48 years) at enrollment with a median follow-up time of 6.1 years (IQR = 4.2-9.1) and well-matched to healthy controls. Most (83%) concussions were evaluated in outpatient settings (5% inpatient). During follow-up, we found significantly higher risks of cardiovascular risks developing including hypertension (hazard ratio [HR] = 1.7, 95% confidence interval [CI]: 1.5-1.9), obesity (HR = 1.7, 95% CI: 1.3-2.0), and diabetes mellitus (HR = 1.8, 95% CI: 1.4-2.3) in the concussion group compared with controls. Similarly, psychiatric and neurological disorders such as depression (HR = 3.0, 95% CI: 2.6-3.5), psychosis (HR = 6.0, 95% CI: 4.2-8.6), stroke (HR = 2.1 95% CI: 1.5-2.9), and epilepsy (HR = 4.4, 95% CI: 3.2-5.9) were higher in the concussion group. Most comorbidities developed less than five years post-concussion. The risks for post-concussion comorbidities were also higher in patients under 40 years old compared with controls. Patients with concussion demonstrated an increased risk of development of medical and behavioral health comorbidities. Prospective studies are warranted to better describe the burden of long-term comorbidities in patients with concussion.
Collapse
Affiliation(s)
- Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Zabreen Tahir
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rachel Grashow
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA
| | - David J Cote
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al Jarrah
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amar Dhand
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Network Science Institute, Northeastern University, Boston, Massachusetts, USA
| | - Herman Taylor
- The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Michael Whalen
- Department of Pediatrics, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David M Nathan
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Diabetes Center, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen K Miller
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Neuroendocrine Unit, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frank Speizer
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Aaron Baggish
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Department of Internal Medicine, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc G Weisskopf
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA
| | - Ross Zafonte
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| |
Collapse
|
9
|
Smith NIJ, Gilmour S, Prescott-Mayling L, Hogarth L, Corrigan JD, Williams WH. A pilot study of brain injury in police officers: A source of mental health problems? J Psychiatr Ment Health Nurs 2021; 28:43-55. [PMID: 32662181 DOI: 10.1111/jpm.12676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/31/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Traumatic brain injury (TBI) has been linked to poor outcomes in terms of mental health, specifically, PTSD, depression and alcohol abuse. A lack of research evidence exists relevant to exploring the presence and implications of TBI in the police in the UK and globally, despite the elevated risk of physical and emotional trauma specific to policing. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The rate of traumatic brain injury is highly prevalent in a small sample of police officers. Traumatic brain injury is a major source of post-concussion symptoms (physical, cognitive and emotional deficits) in police officers, which, in general, are associated with greater mental health difficulties and drinking alcohol to cope. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Traditional mental health treatments should be supplemented with elements of concussion care to address any cognitive, emotional and physical issues due to head injury. Interventions should be made more accessible to those suffering from a mild brain injury. This can be done through regular reminders of appointments, pictograms and by providing a concrete follow-up. ABSTRACT: Introduction Police officers have a high risk of injury through assaults, road traffic incidents and attending domestic calls, with many officers developing post-traumatic stress disorder (PTSD) as a consequence. Traumatic brain injury (TBI) is a common injury in populations involved in conflict and has been extensively linked to mental health difficulties. However, current research has not explored the frequency and sequelae of TBI in police populations, despite the elevated risk of physical and emotional trauma specific to policing. Aim To explore self-reported TBI, PTSD, post-concussion symptoms, depression and drinking to cope in a small sample of UK police, to determine the frequency of these conditions and their relationships. Method Measures of TBI, mental health, and drinking alcohol to cope were administered to 54 police officers from a Midshire Police Constabulary. Results Mild TBI with loss of consciousness was reported by 38.9% of the sample. TBI was associated with increased post-concussion symptoms (PCS). PCS were associated with greater severity of PTSD, depression and drinking to cope. Discussion Exploring TBI in the police could identify a major factor contributing towards ongoing mental health difficulties in a population where, based on previous research, the implications of TBI should not be overlooked, highlighting the need for further research in this area. Implications for Practice This research spans to identify the importance of routine assessment and increasing awareness within mental health services. Mental health treatments should be made amenable to a population with potential memory, planning and impulse control deficits. Further work in mental health services is needed to understand the level of ongoing issues that are due to post-concussion symptoms and those that are due to other mental health difficulties, such as PTSD, thereby educating patients on the association between TBI and emotional difficulties. A graduated return-to-work plan should be developed to enable a safe transition back to work, whilst managing any ongoing symptoms.
Collapse
Affiliation(s)
- Nicholas I J Smith
- School of Psychology, Washington Singer Laboratories, University of Exeter, Exeter, UK
| | | | | | - Lee Hogarth
- School of Psychology, Washington Singer Laboratories, University of Exeter, Exeter, UK
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - W Huw Williams
- School of Psychology, Washington Singer Laboratories, University of Exeter, Exeter, UK
| |
Collapse
|
10
|
Wrenger M, Lange C, Langer M, Heuft G, Burgmer M. Psychiatric disorders after an accident: Predictors and the influence of the psychiatric condition prior to an accident. Eur Psychiatry 2020; 23:434-40. [DOI: 10.1016/j.eurpsy.2008.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 12/12/2007] [Accepted: 02/10/2008] [Indexed: 11/26/2022] Open
Abstract
AbstractBackgroundThe goal of this study is to assess prevalence and incidence of psychiatric sequelae in a sample of inpatient accident survivors. Such an attempt to assess psychiatric conditions that originate due to an accident seems to be important; this does not include psychiatric conditions already present prior to the accident.Method208 accident victims were consecutively examined over a period of 12 months using DSM-IV diagnostic assessment, CAPS, and self-evaluating questionnaires as well as ISS for injury severity. A predictor model for psychiatric disorders was set up.ResultsIncidence of newly developed Axis I disorders in our sample was 14.2% (6 months) and 12.3% (12 months). Incidence of PTSD was 5.9% (6 months) and 2.5% (12 months). Comorbidity was a general phenomenon. The psychiatric condition prior to the accident could be identified as a predictor for the development of Axis I disorders. The subjectively evaluated intensity of experienced threat to life and female gender were the main predictors for the development of PTSD.ConclusionsAccidents can lead to different psychiatric disorders. PTSD as a single diagnosis is rare. Without taking into account pre-existing disorders, the incidence may be overestimated. Two predictor models for the development of PTSD and other mental disorders are presented.
Collapse
|
11
|
Roy D, Peters ME, Everett A, Leoutsakos JM, Yan H, Rao V, Bechtold K, Sair H, Van Meter TE, Falk H, Vassila A, Hall A, Ofoche U, Akbari F, Lyketsos CG, Korley F. Loss of consciousness and altered mental state predicting depressive and post-concussive symptoms after mild traumatic brain injury. Brain Inj 2019; 33:1064-1069. [DOI: 10.1080/02699052.2019.1606447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allen Everett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris Sair
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hayley Falk
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Anna Hall
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uju Ofoche
- Department of Forensic Science, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Freshta Akbari
- Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fredrick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
12
|
Affiliation(s)
- Jacob I. McPherson
- Department of Rehabilitation Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
13
|
Falkenberg L, Zeckey C, Mommsen P, Winkelmann M, Zelle BA, Panzica M, Pape HC, Krettek C, Probst C. Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms? Eur J Med Res 2017; 22:44. [PMID: 29084612 PMCID: PMC5663112 DOI: 10.1186/s40001-017-0282-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Physical impairment is well-known to last for many years after a severe injury, and there is a high impact on the quality of the survivor’s life. The purpose of this study was to examine if this is also true for psychological impairment with symptoms of posttraumatic stress disorder or depression after polytrauma. Design Retrospective cohort outcome study. Setting Level I trauma centre. Population 637 polytrauma trauma patients who were treated at our Level I trauma centre between 1973 and 1990. Minimum follow-up was 10 years after the injury. Methods Patients were asked to fill in a questionnaire, including parts of the Posttraumatic Stress Diagnostic Scale, the Impact of Event Scale-Revised and the German Hospital Anxiety and Depression Scale, to evaluate mental health. Clinical outcome was assessed before by standardised scores. Results Three hundred and twenty-four questionnaires were evaluated. One hundred and forty-nine (45.9%) patients presented with symptoms of mental impairment. Quality of life was significantly higher in the mentally healthy group, while the impaired group achieved a lower rehabilitation status. Conclusions Mental impairment can be found in multiple trauma victims, even after 10 years or more. Treating physicians should not only focus on early physical rehabilitation but also focus on early mental rehabilitation to prevent long-term problems in both physical and mental disability.
Collapse
Affiliation(s)
- Lisa Falkenberg
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Christian Zeckey
- Trauma Department, Hannover Medical School, Hannover, Germany. .,Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Philipp Mommsen
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Boris A Zelle
- Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Panzica
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Probst
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| |
Collapse
|
14
|
Fogleman ND, Naaz F, Knight LK, Stoica T, Patton SC, Olson-Madden JH, Barnhart MC, Hostetter TA, Forster J, Brenner LA, Banich MT, Depue BE. Reduced lateral prefrontal cortical volume is associated with performance on the modified Iowa Gambling Task: A surface based morphometric analysis of previously deployed veterans. Psychiatry Res Neuroimaging 2017; 267:1-8. [PMID: 28672256 DOI: 10.1016/j.pscychresns.2017.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are two of the most common consequences of combat deployment. Estimates of comorbidity of PTSD and mTBI are as high as 42% in combat exposed Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn (OEF/OIF/OND) Veterans. Combat deployed Veterans with PTSD and/or mTBI exhibit deficits in classic executive function (EF) tasks. Similarly, the extant neuroimaging literature consistently indicates abnormalities of the ventromedial prefrontal cortex (vmPFC) and amygdala/hippocampal complex in these individuals. While studies examining deficits in classical EF constructs and aberrant neural circuitry have been widely replicated, it is surprising that little research examining reward processing and decision-making has been conducted in these individuals, specifically, because the vmPFC has long been implicated in underlying such processes. Therefore, the current study employed the modified Iowa Gambling Task (mIGT) and structural neuroimaging to assess whether behavioral measures related to reward processing and decision-making were compromised and related to cortical morphometric features of OEF/OIF/OND Veterans with PTSD, mTBI, or co-occurring PTSD/mTBI. Results indicated that gray matter morphometry in the lateral prefrontal cortex (lPFC) predicted performance on the mIGT among all three groups and was significantly reduced, as compared to the control group.
Collapse
Affiliation(s)
- Nicholas D Fogleman
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Farah Naaz
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Lindsay K Knight
- Interdisciplinary Program in Translational Neuroscience, University of Louisville, Louisville, KY, USA
| | - Teodora Stoica
- Interdisciplinary Program in Translational Neuroscience, University of Louisville, Louisville, KY, USA
| | - Samantha C Patton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Jennifer H Olson-Madden
- VISN 19 Mental Illness Research Education and Clinical Center, Denver, CO, USA; University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Meghan C Barnhart
- VISN 19 Mental Illness Research Education and Clinical Center, Denver, CO, USA; University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Trisha A Hostetter
- VISN 19 Mental Illness Research Education and Clinical Center, Denver, CO, USA; University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Jeri Forster
- VISN 19 Mental Illness Research Education and Clinical Center, Denver, CO, USA; University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa A Brenner
- VISN 19 Mental Illness Research Education and Clinical Center, Denver, CO, USA; University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Marie T Banich
- Institute of Cognitive Science, University of Colorado at Boulder, Boulder, CO, USA; Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO, USA
| | - Brendan E Depue
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA; Interdisciplinary Program in Translational Neuroscience, University of Louisville, Louisville, KY, USA; Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA.
| |
Collapse
|
15
|
Abstract
Mild traumatic brain injury (MTBI) is a significant public health problem worldwide. Injured individuals have an increased relative risk of developing a variety of neuropsychiatric conditions associated with the profile of brain regions typically affected in TBI. Within a neurobiopsychosocial framework, this article reviews what is known about the neuropsychiatric sequelae of MTBI, with an emphasis on recent advances.
Collapse
Affiliation(s)
- Thomas W McAllister
- Dr. McAllister is with the Department of Psychiatry, Indiana University School of Medicine, Indianapolis (e-mail: )
| |
Collapse
|
16
|
Wang X, Xie H, Cotton AS, Brickman KR, Lewis TJ, Wall JT, Tamburrino MB, Bauer WR, Law K, McLean SA, Liberzon I. Early Changes in Cortical Emotion Processing Circuits after Mild Traumatic Brain Injury from Motor Vehicle Collision. J Neurotrauma 2016; 34:273-280. [PMID: 27169480 DOI: 10.1089/neu.2015.4392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mild traumatic brain injury (mTBI) patients frequently experience emotion dysregulation symptoms, including post-traumatic stress. Although mTBI likely affects cortical activation and structure, resulting in cognitive symptoms after mTBI, early effects of mTBI on cortical emotion processing circuits have rarely been examined. To assess early mTBI effects on cortical functional and structural components of emotion processing, we assessed cortical activation to fearful faces within the first 2 weeks after motor vehicle collision (MVC) in survivors who did and did not experience mTBI. We also examined the thicknesses of cortical regions with altered activation. MVC survivors with mTBI (n = 21) had significantly less activation in left superior parietal gyrus (SPG) (-5.9, -81.8, 33.8; p = 10-3.623), left medial orbitofrontal gyrus (mOFG) (-4.7, 36.1, -19.3; p = 10-3.231), and left and right lateral orbitofrontal gyri (lOFG) (left: -16.0, 41.4, -16.6; p = 10-2.573; right: 18.7, 22.7, -17.7; p = 10-2.764) than MVC survivors without mTBI (n = 23). SPG activation in mTBI survivors within 2 weeks after MVC was negatively correlated with subsequent post-traumatic stress symptom severity at 3 months (r = -0.68, p = 0.03). Finally, the SPG region was thinner in the mTBI survivors than in the non-mTBI survivors (F = 11.07, p = 0.002). These results suggest that early differences in activation and structure in cortical emotion processing circuits in trauma survivors who sustain mTBI may contribute to the development of emotion-related symptoms.
Collapse
Affiliation(s)
- Xin Wang
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio.,2 Department of Neurosciences, University of Toledo , Toledo, Ohio.,3 Department of Radiology, University of Toledo , Toledo, Ohio
| | - Hong Xie
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | - Andrew S Cotton
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio
| | | | | | - John T Wall
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | | | - William R Bauer
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | - Kenny Law
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio
| | - Samuel A McLean
- 5 Department of Anesthesiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Israel Liberzon
- 6 Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
| |
Collapse
|
17
|
Popescu M, Hughes JD, Popescu EA, Riedy G, DeGraba TJ. Reduced prefrontal MEG alpha-band power in mild traumatic brain injury with associated posttraumatic stress disorder symptoms. Clin Neurophysiol 2016; 127:3075-3085. [PMID: 27472543 DOI: 10.1016/j.clinph.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine if changes in cortical alpha-band power in patients with mild traumatic brain injury (mTBI) are associated with the severity of their post-traumatic stress disorder (PTSD) symptoms, and if injury severity and level of exposure to psychologically traumatic events are predictors of these electrophysiological changes. METHODS Resting-state magnetoencephalographic recordings were analyzed in 32 patients with mTBI. Alpha-band power was estimated for each patient in 68 cortical regions and was compared between groups of patients with low versus high PTSD symptoms severity. RESULTS Participants with high PTSD symptom severity showed reduced alpha-band power bilaterally in the superior and middle frontal gyri and frontal poles, and in the left inferior frontal gyrus. Alpha-band power in bilateral middle frontal gyri and frontal poles was negatively correlated with scores reflecting symptoms of emotional numbing. Loss of consciousness (LOC) associated with mTBI and level of exposure to psychologically traumatic events were predictors of decreased prefrontal alpha-band power in some of these regions. CONCLUSION Altered prefrontal alpha-band activity, shown to be partly explained by mTBI-related LOC, is associated with PTSD symptoms severity. SIGNIFICANCE Our findings will guide future studies addressing the electrophysiological mechanisms underlying a higher incidence of PTSD in patients with mTBI.
Collapse
Affiliation(s)
- Mihai Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John D Hughes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of NeuroTrauma, Naval Medical Research Center, Silver Spring, MD, USA.
| | - Elena-Anda Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gerard Riedy
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas J DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| |
Collapse
|
18
|
Al-Ozairi A, McCullagh S, Feinstein A. Predicting Posttraumatic Stress Symptoms Following Mild, Moderate, and Severe Traumatic Brain Injury: The Role of Posttraumatic Amnesia. J Head Trauma Rehabil 2015; 30:283-9. [PMID: 24816155 DOI: 10.1097/HTR.0000000000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the relation between posttraumatic amnesia (PTA) and posttraumatic stress symptoms in traumatic brain injury. DESIGN Single-site prospective cohort study. PARTICIPANTS A total of 1114 individuals between the ages of 18 and 65 years with a traumatic brain injury seen on average 3 months following injury. Participants were divided into 4 groups according to their duration of PTA: less than 1 hour; 1 to 24 hours; 24 hours to 1 week; and more than 1 week. MAIN MEASURES Glasgow Coma Scale, PTA, computed tomographic brain scan abnormalities, Impact of Event Scale, the 28-item General Health Questionnaire, and Rivermead Postconcussion Disorder Questionnaire. RESULTS The duration of PTA less than 1 hour was associated with more avoidant (P < .01) and intrusive (P < .001) posttraumatic stress symptoms and more anxiety according to the General Health Questionnaire (P < .01) than other groups. Regression analysis identified PTA and 3 concussive symptoms (light sensitivity, noise intolerance, and difficulties concentrating) as independent predictors of intrusive posttraumatic stress symptoms. CONCLUSION Our data, representative of the full range of traumatic brain injury severity, indicate that a brief duration of PTA is a significant risk factor for the development of posttraumatic stress disorder symptoms. The persistence of certain symptoms of postconcussion disorder adds to the risk by possibly acting as a trigger for reminders of the traumatic event.
Collapse
|
19
|
Huang M, Risling M, Baker DG. The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury. Psychoneuroendocrinology 2016; 63:398-409. [PMID: 25769625 DOI: 10.1016/j.psyneuen.2015.02.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 02/13/2015] [Accepted: 02/15/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pervasive use of improvised explosive devices (IEDs), rocket-propelled grenades, and land mines in the recent conflicts in Iraq and Afghanistan has brought traumatic brain injury (TBI) and its impact on health outcomes into public awareness. Blast injuries have been deemed signature wounds of these wars. War-related TBI is not new, having become prevalent during WWI and remaining medically relevant in WWII and beyond. Medicine's past attempts to accurately diagnose and disentangle the pathophysiology of war-related TBI parallels current lines of inquiry and highlights limitations in methodology and attribution of symptom etiology, be it organic, psychological, or behavioral. New approaches and biomarkers are needed. PRECLINICAL Serological biomarkers and biomarkers of injury obtained with imaging techniques represent cornerstones in the translation between experimental data and clinical observations. Experimental models for blast related TBI and PTSD can generate critical data on injury threshold, for example for white matter injury from acceleration. Carefully verified and validated models can be evaluated with gene expression arrays and proteomics to identify new candidates for serological biomarkers. Such models can also be analyzed with diffusion MRI and microscopy in order to identify criteria for detection of diffuse white matter injuries, such as DAI (diffuse axonal injury). The experimental models can also be analyzed with focus on injury outcome in brain stem regions, such as locus coeruleus or nucleus raphe magnus that can be involved in response to anxiety changes. CLINICAL Mild (and some moderate) TBI can be difficult to diagnose because the injuries are often not detectable on conventional MRI or CT. There is accumulating evidence that injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (ALFMA, peaked at 1-4Hz) that can be measured and localized by magnetoencephalography (MEG). MEG imaging detects TBI abnormalities at the rates of 87% for the mild TBI, group (blast-induced plus non-blast causes) and 100% for the moderate group. Among the mild TBI patients, the rates of abnormalities are 96% and 77% for the blast and non-blast TBI groups, respectively. There is emerging evidence based on fMRI and MEG studies showing hyper-activity in the amygdala and hypo-activity in pre-frontal cortex in individuals with PTSD. MEG signal may serve as a sensitive imaging marker for mTBI, distinguishable from abnormalities generated in association with PTSD. More work is needed to fully describe physiological mechanisms of post-concussive symptoms.
Collapse
Affiliation(s)
- Mingxiong Huang
- Radiology Services, VA San Diego Healthcare System, San Diego, CA, USA; Research Services, VA San Diego Healthcare System, San Diego, CA, USA; Department of Radiology, University of California, San Diego, CA, USA.
| | - Mårten Risling
- Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden
| | - Dewleen G Baker
- Veterans Affairs Center for Excellence in Stress and Mental Health (CESAMH), San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, USA
| |
Collapse
|
20
|
Alway Y, McKay A, Gould KR, Johnston L, Ponsford J. FACTORS ASSOCIATED WITH POSTTRAUMATIC STRESS DISORDER FOLLOWING MODERATE TO SEVERE TRAUMATIC BRAIN INJURY: A PROSPECTIVE STUDY. Depress Anxiety 2016. [PMID: 26219232 DOI: 10.1002/da.22396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study prospectively examined the relationship between preinjury, injury-related, and postinjury factors and posttraumatic stress disorder (PTSD) following moderate to severe traumatic brain injury (TBI). METHOD Two hundred and three participants were recruited during inpatient admission following moderate to severe TBI. Participants completed an initial assessment soon after injury and were reassessed at 3, 6, and 12 months, 2, 3, 4, and 5 years postinjury. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-fourth edition was used to diagnose pre- and postinjury PTSD and other psychiatric disorders. The Glasgow Outcome Scale-Extended (GOSE) and the Quality of Life Inventory (QOLI) were used to evaluate functional and psychosocial outcome from 6 months postinjury. RESULTS The frequency of PTSD ranged between 0.5 and 9.4% during the 5-year period, increasing throughout the first 12 months and declining thereafter. After controlling for other predictors, shorter posttraumatic amnesia duration (odds ratio = 0.96, 95% CI = 0.92-1.00), other concurrent psychiatric disorder (odds ratio = 14.22, 95% CI = 2.68-75.38), and lower GOSE (odds ratio = 0.38, 95% CI = 0.20-0.72) and QOLI scores (odds ratio = 0.97, 95% CI = 0.95-0.97) were associated with greater odds of having injury-related PTSD. DISCUSSION The results of this study indicate that while shorter posttraumatic amnesia duration is associated with PTSD, greater TBI severity does not prevent PTSD from evolving. Patients with PTSD experienced high rates of psychiatric comorbidity and poorer functional and quality of life outcomes after TBI. CONCLUSION There is a need to direct clinical attention to early identification and treatment of PTSD following TBI to improve outcomes.
Collapse
Affiliation(s)
- Yvette Alway
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Kate Rachel Gould
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.,National Trauma Research Institute, Melbourne, Australia
| | - Lisa Johnston
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.,National Trauma Research Institute, Melbourne, Australia
| |
Collapse
|
21
|
Keatley E, d'Alfonso A, Abeare C, Keller A, Bertelsen NS. Health Outcomes of Traumatic Brain Injury Among Refugee Survivors of Torture. J Head Trauma Rehabil 2015; 30:E1-8. [DOI: 10.1097/htr.0000000000000103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Sherer M, Sander AM, Maestas KL, Pastorek NJ, Nick TG, Li J. Accuracy of Self-reported Length of Coma and Posttraumatic Amnesia in Persons With Medically Verified Traumatic Brain Injury. Arch Phys Med Rehabil 2015; 96:652-8. [DOI: 10.1016/j.apmr.2014.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 11/20/2022]
|
23
|
Wang X, Xie H, Cotton AS, Tamburrino MB, Brickman KR, Lewis TJ, McLean SA, Liberzon I. Early cortical thickness change after mild traumatic brain injury following motor vehicle collision. J Neurotrauma 2015; 32:455-63. [PMID: 25118568 DOI: 10.1089/neu.2014.3492] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
In a motor vehicle collision (MVC), survivors often receive mild traumatic brain injuries (mTBI). Although there have been some reports of early white matter changes after an mTBI, much less is known about early cortical structural changes. To investigate early cortical changes within a few days after an MVC, we compared cortical thickness of mTBI survivors with non-mTBI survivors, then reexamined cortical thickness in the same survivors 3 months later. MVC survivors were categorized as mTBI or non-mTBI based on concussive symptoms documented in emergency departments (EDs). Cortical thickness was measured from MRI images using FreeSurfer within a few days and again at 3 months after MVC. Post-traumatic stress symptoms and physical conditions were also assessed. Compared with the non-mTBI group (n = 23), the mTBI group (n = 21) had thicker cortex in the left rostral middle frontal (rMFG) and right precuneus gyri, but thinner cortex in the left posterior middle temporal gyrus at 7.2 ± 3.1 days after MVC. After 3 months, cortical thickness had decreased in left rMFG in the mTBI group but not in the non-mTBI group. The cortical thickness of the right precuneus region in the initial scans was positively correlated with acute traumatic stress symptoms for all survivors and with the number of reduced activity days for mTBI survivors who completed the follow-up. The preliminary results suggest that alterations in cortical thickness may occur at an early stage of mTBI and that frontal cortex structure may change dynamically over the initial 3 months after mTBI.
Collapse
Affiliation(s)
- Xin Wang
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Mallya S, Sutherland J, Pongracic S, Mainland B, Ornstein TJ. The manifestation of anxiety disorders after traumatic brain injury: a review. J Neurotrauma 2015; 32:411-21. [PMID: 25227240 DOI: 10.1089/neu.2014.3504] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The development of anxiety disorders after a traumatic brain injury (TBI) is a strong predictor of social, personal, and work dysfunction; nevertheless, the emergence of anxiety has been largely unexplored and poorly understood in the context of TBI. This article provides an overview of the limited published research to date on anxiety disorders that are known to develop after TBI, including post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, specific phobia, and social anxiety disorder. This review also examines diagnostic criteria, the epidemiology of each disorder, and the factors that influence the expression of these conditions, including injury-related and psychosocial variables. Putative neural correlates will be reviewed where known. A discussion of current treatment options and avenues for further research are explored.
Collapse
|
25
|
Abstract
Disentangling the effects of "organic" neurologic damage and psychological distress after a traumatic brain injury poses a significant challenge to researchers and clinicians. Establishing a link between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) has been particularly contentious, reflecting difficulties in establishing a unique diagnosis for conditions with overlapping and sometimes contradictory symptom profiles. However, each disorder is linked to a variety of adverse health outcomes, underscoring the need to better understand how neurologic and psychiatric risk factors interact following trauma. Here, we present data showing that individuals with a TBI are more likely to develop PTSD, and that individuals with PTSD are more likely to develop persistent cognitive sequelae related to TBI. Further, we describe neurobiological models of PTSD, highlighting how patterns of neurologic damage typical in TBI may promote or protect against the development of PTSD in brain-injured populations. These data highlight the unique course of PTSD following a TBI and have important diagnostic, prognostic, and treatment implications for individuals with a dual diagnosis.
Collapse
Affiliation(s)
- Julian C Motzkin
- Neuroscience Training Program, University of Wisconsin - Madison, Madison, WI, USA; Medical Scientist Training Program, University of Wisconsin - Madison, Madison, WI, USA
| | - Michael R Koenigs
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI, USA.
| |
Collapse
|
26
|
Abstract
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has removed criterion A2 from the diagnosis of posttraumatic stress disorder. The current study aimed to assess the claim that criterion A2 has low use in predicting distress, while addressing the shortcomings of previous research looking at criteria A1 and A2. Data from a longitudinal, prospective study was used, with 933 women having been assessed at four time points both prebirth and postbirth. In our sample of women, model comparisons suggest that criterion A2 should be reintroduced into the diagnostic criteria as it provides a better indicator of who goes on to have problems after giving birth than criterion A1 on its own. There is also evidence that this subjective reaction to event confrontation (A2) should include anger, shame, and guilt.
Collapse
|
27
|
Stocker RPJ, Cieply MA, Paul B, Khan H, Henry L, Kontos AP, Germain A. Combat-related blast exposure and traumatic brain injury influence brain glucose metabolism during REM sleep in military veterans. Neuroimage 2014; 99:207-14. [PMID: 24893322 PMCID: PMC4112017 DOI: 10.1016/j.neuroimage.2014.05.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/30/2014] [Accepted: 05/24/2014] [Indexed: 12/01/2022] Open
Abstract
Traumatic brain injury (TBI), a signature wound of Operations Enduring and Iraqi Freedom, can result from blunt head trauma or exposure to a blast/explosion. While TBI affects sleep, the neurobiological underpinnings between TBI and sleep are largely unknown. To examine the neurobiological underpinnings of this relationship in military veterans, [(18)F]-fluorodeoxyglucose positron emission tomography (FDG PET) was used to compare mTBI-related changes in relative cerebral metabolic rate of glucose (rCMRglc) during wakefulness, Rapid Eye Movement (REM) sleep, and non-REM (NREM) sleep, after adjusting for the effects of posttraumatic stress (PTS). Fourteen veterans with a history of blast exposure and/or mTBI (B/mTBI) (age 27.5±3.9) and eleven veterans with no history (No B/mTBI) (age 28.1±4.3) completed FDG PET studies during wakefulness, REM sleep, and NREM sleep. Whole-brain analyses were conducted using Statistical Parametric Mapping (SPM8). Between group comparisons revealed that B/mTBI was associated with significantly lower rCMRglc during wakefulness and REM sleep in the amygdala, hippocampus, parahippocampal gyrus, thalamus, insula, uncus, culmen, visual association cortices, and midline medial frontal cortices. These results suggest that alterations in neurobiological networks during wakefulness and REM sleep subsequent to B/mTBI exposure may contribute to chronic sleep disturbances and differ in individuals with acute symptoms.
Collapse
Affiliation(s)
- Ryan P J Stocker
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Counseling Psychology, Chatham University, Pittsburgh, PA, USA
| | | | - Benjamin Paul
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hassen Khan
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Luke Henry
- Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | | | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
28
|
Mounce LT, Williams WH, Jones JM, Harris A, Haslam SA, Jetten J. Neurogenic and psychogenic acute postconcussion symptoms can be identified after mild traumatic brain injury. J Head Trauma Rehabil 2013; 28:397-405. [PMID: 22691962 DOI: 10.1097/HTR.0b013e318252dd75] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES As provenance of postconcussion symptoms after mild traumatic brain injury (mTBI) is controversial, with similar rates found in other populations, we aimed to identify postconcussion symptoms specific to mTBI compared with controls. We also compared differences between complicated and uncomplicated mTBIs. SETTING Hospital emergency department. PARTICIPANTS Adult individuals (34 individuals with complicated mTBI, 76 individuals with uncomplicated mTBI, and 47 orthopedic controls) who sought care in the emergency department and were consecutively recruited by post at 2 weeks postinjury. MAIN MEASURES Rivermead Postconcussion Symptom Questionnaire. Preinjury factors were used as covariates. RESULTS Compared with orthopedic controls, complicated mTBI group reported greater severity of headaches, dizziness, and nausea, as well as concentration difficulties, suggesting that these are neurogenic. Severity of other symptoms measured on the Rivermead Postconcussion Symptom Questionnaire was not significantly different between these groups, suggesting that these are psychogenic. Differences were evident between the 2 mTBI samples on the items of dizziness, nausea, fatigue, sleep disturbance, and concentration difficulties. CONCLUSIONS Neurogenic and psychogenic postconcussion symptoms were identified at the acute-phase postinjury. Findings suggest that treating persons with mTBI as a homogenous sample is not prudent. This should inform prognostic models and follow-up support offered after leaving the emergency department.
Collapse
|
29
|
Depue BE, Olson-Madden JH, Smolker HR, Rajamani M, Brenner LA, Banich MT. Reduced amygdala volume is associated with deficits in inhibitory control: a voxel- and surface-based morphometric analysis of comorbid PTSD/mild TBI. Biomed Res Int 2014; 2014:691505. [PMID: 24724093 DOI: 10.1155/2014/691505] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/11/2014] [Indexed: 11/17/2022]
Abstract
A significant portion of previously deployed combat Veterans from Operation Enduring Freedom and Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) are affected by comorbid posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Despite this fact, neuroimaging studies investigating the neural correlates of cognitive dysfunction within this population are almost nonexistent, with the exception of research examining the neural correlates of diagnostic PTSD or TBI. The current study used both voxel-based and surface-based morphometry to determine whether comorbid PTSD/mTBI is characterized by altered brain structure in the same regions as observed in singular diagnostic PTSD or TBI. Furthermore, we assessed whether alterations in brain structures in these regions were associated with behavioral measures related to inhibitory control, as assessed by the Go/No-go task, self-reports of impulsivity, and/or PTSD or mTBI symptoms. Results indicate volumetric reductions in the bilateral anterior amygdala in our comorbid PTSD/mTBI sample as compared to a control sample of OEF/OIF Veterans with no history of mTBI and/or PTSD. Moreover, increased volume reduction in the amygdala predicted poorer inhibitory control as measured by performance on the Go/No-go task, increased self-reported impulsivity, and greater symptoms associated with PTSD. These findings suggest that alterations in brain anatomy in OEF/OIF/OND Veterans with comorbid PTSD/mTBI are associated with both cognitive deficits and trauma symptoms related to PTSD.
Collapse
|
30
|
Roitman P, Gilad M, Ankri YLE, Shalev AY. Head injury and loss of consciousness raise the likelihood of developing and maintaining PTSD symptoms. J Trauma Stress 2013; 26:727-34. [PMID: 24265212 DOI: 10.1002/jts.21862] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mild traumatic brain injury has been associated with higher prevalence of posttraumatic stress disorder (PTSD). The extent to which head injury or loss of consciousness predicts PTSD is unknown. To evaluate the contribution of head injury and loss of consciousness to the occurrence of PTSD, we made a longitudinal evaluation of 1,260 road accident survivors admitted to the emergency department with head injury (n = 287), head injury and loss of consciousness (n = 115), or neither (n = 858). A telephone-administered posttraumatic symptoms scale inferred PTSD and quantified PTSD symptoms at 10 days and 8 months after admission. The study groups had similar heart rate, blood pressure, and pain levels in the emergency department. Survivors with loss of consciousness and head injury had higher prevalence of PTSD and higher levels of PTSD symptoms, suggesting that patients with head injury and loss of consciousness reported in the emergency department are at higher risk for PTSD.
Collapse
Affiliation(s)
- Pablo Roitman
- Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
| | | | | | | |
Collapse
|
31
|
Heron-Delaney M, Kenardy J, Charlton E, Matsuoka Y. A systematic review of predictors of posttraumatic stress disorder (PTSD) for adult road traffic crash survivors. Injury 2013; 44:1413-22. [PMID: 23916902 DOI: 10.1016/j.injury.2013.07.011] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/09/2013] [Accepted: 07/09/2013] [Indexed: 02/02/2023]
Abstract
Posttraumatic stress disorder (PTSD) is one of the most common psychological consequences for adult road traffic crash (RTC) survivors and can have serious and long-lasting consequences for recovery if left untreated. Prevalence rates of PTSD following a RTC vary from 6% to 45% (based on 51 prevalence estimates across 35 studies). Explanations for this wide variance are explored. A systematic review of published studies found 49 papers (44 unique studies) investigating predictors of later PTSD in RTC survivors. Consistent predictors of PTSD include rumination about the trauma, perceived threat to life, a lack of social support, higher Acute Stress Disorder symptom severity, persistent physical problems, previous emotional problems, previous anxiety disorder and involvement in litigation/compensation. Moderate predictors of PTSD are discussed, as well as factors, which consistently do not predict PTSD in RTC survivors. The results inform future models of post-RTC traumatic stress aetiology.
Collapse
Affiliation(s)
- Michelle Heron-Delaney
- School of Medicine, Centre of National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Royal Brisbane and Women's Hospital, Level 1 Edith Cavell Building, Herston, QLD 4029, Australia.
| | | | | | | |
Collapse
|
32
|
Rapp PE, Rosenberg BM, Keyser DO, Nathan D, Toruno KM, Cellucci CJ, Albano AM, Wylie SA, Gibson D, Gilpin AMK, Bashore TR. Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders. Front Neurol 2013; 4:91. [PMID: 23885250 PMCID: PMC3717660 DOI: 10.3389/fneur.2013.00091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/26/2013] [Indexed: 12/20/2022] Open
Abstract
Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant's clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.
Collapse
Affiliation(s)
- Paul E. Rapp
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Brenna M. Rosenberg
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - David O. Keyser
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Dominic Nathan
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Kevin M. Toruno
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | | | | | - Scott A. Wylie
- Neurology Department, Vanderbilt UniversityNashville, TN, USA
| | - Douglas Gibson
- Combat Casualty Care Directorate, Army Medical Research and Materiel CommandFort Detrick, MD, USA
| | - Adele M. K. Gilpin
- Arnold and Porter, LLPWashington, DC, USA
- Department of Epidemiology and Preventive Medicine, University of MarylandCollege Park, MD, USA
| | | |
Collapse
|
33
|
Wu KK, Li FW, Cho VW. A Randomized Controlled Trial of the Effectiveness of Brief-CBT for Patients with Symptoms of Posttraumatic Stress Following a Motor Vehicle Crash. Behav Cogn Psychother 2014; 42:31-47. [DOI: 10.1017/s1352465812000859] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Motor vehicle crashes (MVCs) are leading contributors to the global burden of disease. Patients attending accident and emergency (A&E) after an MVC may develop symptoms of posttraumatic stress disorder (PTSD). There is evidence that brief cognitive behavioural therapy (B-CBT) can be effective in treating PTSD; however, there are few studies of the use of B-CBT to treat PTSD in MVC survivors. Aims: This study examined the effects of B-CBT and a self-help program on the severity of psychological symptoms in MVC survivors at risk of developing PTSD. Method: Sixty participants who attended A&E after a MVC were screened for PTSD symptoms and randomized to a 4-weekly session B-CBT or a 4-week self-help program (SHP) booklet treatment conditions. Psychological assessments were completed at baseline (1-month post-MVC) and posttreatment (3- and 6-month follow-ups) by utilizing Impact of Event Scale-Revised (IES-R) and Hospital Anxiety and Depression Scale (HADS). Results: There were significant improvements in the measures of anxiety, depression, and PTSD symptoms over time. Participants treated with B-CBT showed greater reductions in anxiety at 3-month and 6-month follow-ups, and in depression at 6-month follow-up. A comparison of effect size favoured B-CBT for the reduction of anxiety and depression symptoms measured by HADS. A high level of pretreatment anxiety and depression were predictive of negative outcome at 6-month follow-up in the SHP condition. There was no differential effect on PTSD symptoms measured by IES-R. Conclusions: This trial supports the efficacy of providing B-CBT as a preventive strategy to improve psychological symptoms after an MVC.
Collapse
|
34
|
Abstract
Psychotherapy plays an essential role in the treatment of mental disorders. The use and research of psychological treatment strategies increased drastically over the past decade. The general efficacy of psychotherapy for the treatment of psychiatric diseases is proved and documented in several meta-analyses. Psychotherapy re-searchers have found solutions for acceptable study designs which account for the special character of these interventions and studied the efficacy of psychotherapeutic treatment in more than 1000 intervention trials.Meanwhile evidence-based psychotherapy approaches tailored to a specific diagnosis are dominating the field and question the basis of psychotherapy schools.A new field of research in psychotherapy is the neurobiological basis of mental disorders and the demonstration of neurobiological changes with psycho-therapeutic treatment.
Collapse
Affiliation(s)
- E Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | | | | | | |
Collapse
|
35
|
Chossegros L, Hours M, Charnay P, Bernard M, Fort E, Boisson D, Sancho PO, Yao SN, Laumon B. Predictive factors of chronic post-traumatic stress disorder 6 months after a road traffic accident. Accid Anal Prev 2011; 43:471-477. [PMID: 21094346 DOI: 10.1016/j.aap.2010.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/28/2010] [Accepted: 10/01/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. METHODS The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhône area administrative département. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. RESULTS 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥ 44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR=0.4; 0.2-0.9). CONCLUSION Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users.
Collapse
Affiliation(s)
- Laetitia Chossegros
- Transport Work and Environmental Epidemiology Research and Surveillance Unit - UMRESTTE (UMR T9405) Université de Lyon, INRETS, InVS 69500 Bron, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
The current conflicts in Iraq and Afghanistan have resulted in a large cohort of military personnel exposed to combat-related psychological trauma as well as biomechanical trauma, including proximity to blast events. Historically, the long-term effects of both types of trauma have been viewed as having different neural substrates, with some controversy over the proper attribution of such symptoms evident after each of the major conflicts of the last century. Recently, great effort has been directed toward distinguishing which neuropsychiatric sequelae are due to which type of trauma. Of interest, however, is that the chronic effects of exposure to either process are associated with a significant overlap in clinical symptoms. Furthermore, similar brain regions are vulnerable to the effects of either psychological or biomechanical trauma, raising the possibility that shared mechanisms may underlie the clinically observed overlap in symptom profile. This paper reviews the literature on the neural substrate of biomechanical and psychological injury and discusses the implications for evaluation and treatment of the neuropsychiatric sequelae of these processes.
Collapse
Affiliation(s)
- Thomas W McAllister
- Department of Psychiatry, Section of Neuropsychiatry, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.
| | | |
Collapse
|
37
|
Hajek CA, Yeates KO, Gerry Taylor H, Bangert B, Dietrich A, Nuss KE, Rusin J, Wright M. Relationships among post-concussive symptoms and symptoms of PTSD in children following mild traumatic brain injury. Brain Inj 2010; 24:100-9. [PMID: 20085447 DOI: 10.3109/02699050903508226] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To investigate the occurrence of post-concussive symptoms (PCS) and symptoms of post-traumatic stress disorder (PTSD) in children following mild traumatic brain injuries (TBI). RESEARCH DESIGN Longitudinal study comparing the outcomes of mild TBI and orthopaedic injuries (OI) in children aged 8-15. METHODS AND PROCEDURES One hundred and eighty-six children with mild TBI and 99 with OI were recruited prospectively. Parents rated children's PCS and symptoms of PTSD at 2 weeks, 3 months and 12 months post-injury. One hundred and sixty-seven with mild TBI and 84 with OI completed all assessments. MAIN OUTCOMES AND RESULTS Controlling for symptoms of PTSD, the mild TBI group demonstrated more PCS than the OI group, although the magnitude of group differences diminished with time. Controlling for PCS, the OI group displayed more symptoms of PTSD than the mild TBI group at baseline, but not thereafter. Symptoms of PTSD and PCS were correlated significantly, but more highly in the OI group than the mild TBI group. CONCLUSIONS Although PCS and symptoms of PTSD are correlated, children with mild TBI are more distinguishable from children with OI based on PCS than on symptoms of PTSD. The latter symptoms, moreover, do not account for increased PCS following mild TBI in children.
Collapse
Affiliation(s)
- Christine A Hajek
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Wrenger M, Lange C, Langer M, Heuft G, Burgmer M. [The influence of different accident types on the process of trauma adaption and psychosocial adjustment]. Z Psychosom Med Psychother 2010; 56:163-78. [PMID: 20623461 DOI: 10.13109/zptm.2010.56.2.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Accidents often have a traumatic impact on the victims. The influence of individual trauma adjustment on psychosocial convalescence is examined according to the different types of accidental event. METHODS 192 accident victims were consecutively examined over a period of 12 months. Subjective trauma evaluation and characteristics of trauma adjustment were assessed and differentiated according to the type of accidental event (motor-vehicle, work, and recreational activity accident). RESULTS The three groups varied in their demographics, in injury severity (ISS), in subjective evaluation, in symptoms of mental and posttraumatic stress, and in the predicting variables. The lowest level of stress after 12 months was found after accidents that had occurred during recreational activities. The prevalence of posttraumatic stress symptoms was similar among motor-vehicle and work-accident victims, whereas victims of recreational activity accidents primarily showed symptoms of other Axis I disorders. CONCLUSIONS Individual adjustment to trauma and the type of accident influence mental health. The role of other variables (work re-entry, claims, financial compensation) also has to be considered. We accentuate the need for immediate psychiatric evaluation and intervention when necessary.
Collapse
|
39
|
|
40
|
Yeates G. Posttraumatic Stress Disorder after Traumatic Brain Injury and Interpersonal Relationships: Contributions from Object-Relations Perspectives. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/15294145.2009.10773613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
41
|
Abstract
A number of controversies and debates have arisen over the years surrounding the dual diagnosis of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Many of these have centred around the around the degree of protection provided by TBI against developing the disorder. The following is brief review of the literature in this area to help resolve some of these issues and to address a number of specific challenges which arise when working with this patient group.
Collapse
Affiliation(s)
- Nigel S King
- Community Head Injury Service, The Camborne Centre, Bedgrove, Aylesbury, Bucks, UK.
| |
Collapse
|
42
|
|
43
|
|
44
|
Tiesman HM, Peek-Asa C, Whitten P, Sprince NL, Stromquist A, Zwerling C. Depressive symptoms as a risk factor for unintentional injury: a cohort study in a rural county. Inj Prev 2007; 12:172-7. [PMID: 16751447 PMCID: PMC2563511 DOI: 10.1136/ip.2006.011544] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The authors used data from a population based prospective cohort study to determine if depressive symptoms predicted incidence of unintentional injury. METHODS The Keokuk County Rural Health Study, based in Iowa, is a prospective cohort study of health status that includes injury outcomes. Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale at the beginning of the study on 1493 participants. Quarterly follow up phone calls were made to measure injury incidence. RESULTS 471 injuries were reported for an overall injury rate of 9.8 per 100 person-years. Crude injury rates were significantly higher for those with depressive symptoms (p = 0.0003). Those with depressive symptoms had a 41% increased risk for injury after controlling for antidepressant medication use, gender, prior injury, income, and sleepiness (RR = 1.41, 95% CI 1.10 to 1.80). Depressive symptoms remained a risk factor for injury regardless of current antidepressant medication use (no medication use, RR = 1.43, 95% CI 1.09 to 1.88; medication use, RR = 1.31, 95% CI 0.76 to 2.26). CONCLUSIONS Depressive symptoms were found to be risk factors for unintentional injury. Medical practitioners should consider talking about safety with their patients, especially those reporting symptoms of depression, and recognize that an increased risk for injury remains until the depressive symptoms subside.
Collapse
Affiliation(s)
- H M Tiesman
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Sojka P, Stålnacke BM, Björnstig U, Karlsson K. One-year follow-up of patients with mild traumatic brain injury: occurrence of post-traumatic stress-related symptoms at follow-up and serum levels of cortisol, S-100B and neuron-specific enolase in acute phase. Brain Inj 2007; 20:613-20. [PMID: 16754286 DOI: 10.1080/02699050600676982] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate serum levels of cortisol (a biochemical marker of stress), S-100B and neuron-specific enolase (two biochemical markers of brain tissue injury), in acute phase in mild traumatic brain injury patients and the occurrence of post-traumatic stress-related symptoms 1 year after the trauma. METHODS Blood samples were taken in patients (n = 88) on admission and approximately 7 hours later for analysis. Occurrence of post-traumatic stress-related symptoms was assessed for 69 patients using items from the Impact of Event Scale questionnaire (IES) at follow-up at 15 +/- 4 months after the injury. RESULTS Serum levels of cortisol were more increased in the first sample (cortisol/1, 628.9 +/- 308.9 nmol L-1) than in the second blood sample (cortisol/2, 398.2 +/- 219.4 nmol L-1). The difference between these samples was statistically significant (p < 0.001). Altogether 12 patients (17%) showed post-traumatic stress related symptoms at the time of the follow-up. Stepwise forward logistic regression analysis of symptoms and serum concentrations of markers revealed that only S-100B in the second sample was statistically significantly (p < 0.05) associated to symptoms (three symptoms of the avoidance sub-set of IES). CONCLUSION A major increase in serum concentrations of cortisol indicates that high stress levels were reached by the patients, in particular shortly ( approximately 3 hours) after the trauma. The association between the occurrence of post-traumatic stress related symptoms and serum levels of S-100B (generally considered as a biochemical marker of brain injury) seem to reflect the complexity of interactions between brain tissue injury and the ensemble of stress reactions.
Collapse
Affiliation(s)
- Peter Sojka
- Department of Community Medicine and Rehabilitation, Umeå University Hospital, Umeå University, Sweden.
| | | | | | | |
Collapse
|
46
|
Buitenhuis J, de Jong PJ, Jaspers JPC, Groothoff JW. Relationship between posttraumatic stress disorder symptoms and the course of whiplash complaints. J Psychosom Res 2006; 61:681-9. [PMID: 17084147 DOI: 10.1016/j.jpsychores.2006.07.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 07/06/2006] [Accepted: 07/11/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study investigates the relationship between posttraumatic stress disorder (PTSD) symptoms (avoidance, reexperiencing, and hyperarousal) and the presence, severity, and duration of neck complaints after motor vehicle accidents. METHODS Individuals who had been involved in traffic accidents and had initiated compensation claim procedures with a Dutch insurance company were sent questionnaires (Q1) containing complaint-related questions and the Self-Rating Scale for PTSD. Of the 997 questionnaires that were dispatched, 617 (62%) were returned. Only car accident victims were included in this study (n=240). Complaints were monitored using additional questionnaires that were administered 6 months (Q2) and 12 months (Q3) after the accident. RESULTS PTSD was related to the presence and severity of concurrent post-whiplash syndrome. More specifically, the intensity of hyperarousal symptoms that were related to PTSD at Q1 was found to have predictive validity for the persistence and severity of post-whiplash syndrome at 6 and 12 months follow-up. CONCLUSION Results are consistent with the idea that PTSD hyperarousal symptoms have a detrimental influence on the recovery and severity of whiplash complaints following car accidents.
Collapse
|
47
|
Gordon WA, Zafonte R, Cicerone K, Cantor J, Brown M, Lombard L, Goldsmith R, Chandna T. Traumatic brain injury rehabilitation: state of the science. Am J Phys Med Rehabil 2006; 85:343-82. [PMID: 16554685 DOI: 10.1097/01.phm.0000202106.01654.61] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Wayne A Gordon
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Sampalis JS, Liberman M, Davis L, Angelopoulos J, Longo N, Joch M, Sampalis F, Nikolis A, Lavoie A, Denis R, Mulder DS. Functional Status and Quality of Life in Survivors of Injury Treated at Tertiary Trauma Centers: What Are We Neglecting? ACTA ACUST UNITED AC 2006; 60:806-13. [PMID: 16612301 DOI: 10.1097/01.ta.0000215103.62783.4d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to describe the functional status and quality of life (QOL) of patients at 12 months after injury. METHODS Retrospective study consisting of patients treated at three tertiary trauma centers for injuries. Functional capacity (FC) was measured using the Sickness Impact Profile and QOL was measured using the Medical Outcomes Study Short Form (MOS SF-36) at approximately 12 months after the date of injury. RESULTS There were 144 patients that fulfilled the study inclusion and exclusion criteria. The mean duration of follow-up was 1.3 years, with a range of 0.8 to 1.5 years. Age and gender were not associated with the FC or QOL. The mean(standard deviation) Injury Severity Score (ISS) was 18.9(9.4), whereas ISS category distribution was 1 to 11 (22.9%), 12 to 24 (50.0%), and 25 to 49 (27.1%). Patients with an ISS of 25 to 49 had significantly worse physical (p = 0.008) and total (p = 0.023) Sickness Impact Profile scores and had more physical functioning (p = 0.096), emotional role functioning (p = 0.080), and energy (p = 0.017) impairments when compared with those with an ISS less than 24. Patients injured in motor vehicle collisions had significantly impaired psychosocial function (p = 0.031), whereas those injured in falls had reduced quality of life scores for physical function (p = 0.089), physical role (p = 0.066), and mental health (p = 0.081). CONCLUSION Patients who survive injuries experience residual impairments in FC and QOL for as long as 1 year after injury. Changes to the long-term management of these patients should be considered.
Collapse
Affiliation(s)
- John S Sampalis
- Department of Surgery, McGill University Health Center, Montreal General Hospital, Quebec, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Creamer M, O'Donnell ML, Pattison P. Amnesia, traumatic brain injury, and posttraumatic stress disorder: a methodological inquiry. Behav Res Ther 2006; 43:1383-9. [PMID: 16086988 DOI: 10.1016/j.brat.2004.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Revised: 11/08/2004] [Accepted: 11/15/2004] [Indexed: 11/24/2022]
Abstract
This study explored the relationship between mild traumatic brain injury (MTBI), amnesia, and posttraumatic stress disorder (PTSD). MTBI status and amnesia for the event were assessed in 307 consecutive admissions to a Level 1 Trauma Center. Amnesia did not always occur concurrently with MTBI: 18% of those with MTBI had full recall and over half had partial recall of the event. Just over 10% of participants developed PTSD by 12 months post-injury, with prevalence comparable across MTBI and non-MTBI groups. Non-significant differences in incidence of PTSD were apparent between those with full recall (9%), partial recall (14%) and no recall (7%). These data highlight the fact that PTSD may develop following trauma despite amnesia for the event, and illustrate the importance in both clinical and research settings of carefully examining the extent of amnesia.
Collapse
Affiliation(s)
- Mark Creamer
- Australian Centre for Posttraumatic Mental Health, ARMC Repat Campus, PO Box 5444, Heidelberg, Victoria 3081, Australia.
| | | | | |
Collapse
|
50
|
Hepp U, Moergeli H, Büchi S, Wittmann L, Schnyder U. Coping with serious accidental injury: a one-year follow-up study. Psychother Psychosom 2006; 74:379-86. [PMID: 16244515 DOI: 10.1159/000087786] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to analyze changes of coping strategies in severely injured accident victims over time and to compare patients with high and low posttraumatic stress disorder (PTSD) symptom levels with regard to their coping patterns and accident-related cognitions. METHODS 106 consecutive patients with severe accidental injuries admitted to a trauma surgery intensive care unit (ICU) were assessed within 1 month after the trauma and 6 and 12 months later. Assessments included a clinical interview, the Freiburg Questionnaire of Coping with Illness, the patients' accident-related cognitions, the Clinician-Administered PTSD Scale, the 90-item revised Symptom Checklist (SCL-90-R), and the Sense of Coherence Questionnaire (SOC). Patients who met the criteria for either full or subsyndromal PTSD at least once over the observation period (36 subjects; 34.0%) were assigned to a highly symptomatic group (HSG), the remainder (70 subjects; 66.0%) to a less symptomatic group. RESULTS Overall, active problem-focused coping was predominant immediately after the accident and declined over time, with a stronger decrease in the HSG. Patients in the HSG scored higher on the SCL Global Severity Index and lower on the SOC. The patients' subjective appraisal of accident severity was higher in the HSG, whereas there was no group difference with regard to accident-related variables such as type of accident, injury severity and mild to moderate traumatic brain injury. CONCLUSIONS Active problem-focused coping, although utilized most frequently and often regarded as protective, might be an inadequate strategy in face of acute stress following a severe accident. Clinicians should not expect their patients to cope very actively in the acute ICU phase. In the subsequent rehabilitation, active coping seems to be more adaptive.
Collapse
Affiliation(s)
- Urs Hepp
- Department of Psychiatry, University Hospital, Zurich, Switzerland.
| | | | | | | | | |
Collapse
|