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Jak AJ, Jurick S, Hoffman S, Evangelista ND, Deford N, Keller A, Merritt VC, Sanderson-Cimino M, Sorg S, Delano-Wood L, Bangen KJ. PTSD, but not history of mTBI, is associated with altered myelin in combat-exposed Iraq and Afghanistan Veterans. Clin Neuropsychol 2020; 34:1070-1087. [PMID: 32176590 DOI: 10.1080/13854046.2020.1730975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the biological, cognitive, and psychological presentations of combat-exposed Veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) using a novel white matter imaging technique and comprehensive neuropsychological assessment. METHOD 74 Iraq and Afghanistan Veterans (mean age 33.89, 90.5% male) with history of mTBI (average 7.25 years since injury), PTSD, both, or neither underwent magnetic resonance imaging (MRI) exams including acquisition of a novel imaging technique, multicomponent-driven equilibrium single-pulse observation of T1/T2 (mcDESPOT) to quantify myelin water fraction (MWF), a surrogate measure of myelin content. Participants also underwent comprehensive neuropsychological assessment and three cognitive composite scores (memory, working memory/processing speed, and executive functioning) were created. RESULTS There were no significant group differences on the neuropsychological composite scores. ANCOVAs revealed a main effect of PTSD across all a priori regions of interest (ROI) in which PTSD was associated with higher MWF. There was no main effect of mTBI history or TBI by PTSD interaction on any ROI. Significant positive associations were observed between myelin and PTSD symptoms, but no significant associations were found between myelin and neurobehavioral symptoms. No significant associations were found between myelin in the a priori ROIs and the cognitive composite scores. CONCLUSION This study did not find neuropsychological or MWF differences in combat Veterans with a remote history of mTBI but did find myelin alterations related to PTSD. Psychological trauma should be a primary target for intervention in Veterans with comorbid PTSD and mTBI reporting subjective complaints, given its salience.
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Affiliation(s)
- Amy J Jak
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA.,VASDHS Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.,Department of Psychiatry, San Diego School of Medicine, University California, San Diego, CA, USA
| | - Sarah Jurick
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA.,VASDHS Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Samantha Hoffman
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Department of Psychiatry, San Diego School of Medicine, University California, San Diego, CA, USA
| | - Nicole D Evangelista
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Amber Keller
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Victoria C Merritt
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Mark Sanderson-Cimino
- Department of Psychiatry, San Diego School of Medicine, University California, San Diego, CA, USA
| | - Scott Sorg
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Department of Psychiatry, San Diego School of Medicine, University California, San Diego, CA, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA.,VASDHS Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.,Department of Psychiatry, San Diego School of Medicine, University California, San Diego, CA, USA
| | - Katherine J Bangen
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Department of Psychiatry, San Diego School of Medicine, University California, San Diego, CA, USA
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Mikolić A, Polinder S, Retel Helmrich IRA, Haagsma JA, Cnossen MC. Treatment for posttraumatic stress disorder in patients with a history of traumatic brain injury: A systematic review. Clin Psychol Rev 2019; 73:101776. [PMID: 31707182 DOI: 10.1016/j.cpr.2019.101776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/27/2019] [Accepted: 08/21/2019] [Indexed: 01/10/2023]
Abstract
Posttraumatic stress disorder (PTSD) frequently co-occurs with traumatic brain injury (TBI). We conducted a systematic review to evaluate the appropriateness and effectiveness of treatments for PTSD in adult patients with a history of TBI. We searched for longitudinal studies aimed at treatments for PTSD patients who sustained a TBI, published in English between 1980 and February 2019. Twenty-three studies were found eligible, and 26 case studies were included for a separate overview. The quality of eligible studies was assessed using the Research Triangle Institute item bank. The majority of studies included types of cognitive-behavioral therapy (CBT) in male service members and veterans with a history of mild TBI in the United States. Studies using prolonged exposure (PE), cognitive-processing therapy (CPT) or other types of CBT, usually in combination with additional treatments, showed favorable outcomes. A smaller number of studies described complementary and novel therapies, which showed promising results. Overall, the quality of studies was considered low. We concluded that CBT seem appropriate for the patient population with history of TBI. The evidence is less strong for other therapies. We recommend controlled studies of PTSD treatments including more female patients and those with a history of moderate to severe TBIs in civilian and military populations.
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Affiliation(s)
- Ana Mikolić
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | | | - Juanita A Haagsma
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Maryse C Cnossen
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
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Review of the Management of Pediatric Post-Concussion Syndrome-a Multi-Disciplinary, Individualized Approach. Curr Rev Musculoskelet Med 2019; 12:57-66. [PMID: 30758705 DOI: 10.1007/s12178-019-09533-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Post-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS. RECENT FINDINGS There is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms. Vestibular-ocular dysfunction should be evaluated and managed appropriately. Neuropsychological recovery is expected, but requires appropriate attention to Return to Learn. Emotional symptoms are common in PCS and the evidence supports treatment with cognitive behavioral therapy. PCS presents a unique therapeutic challenge affecting multiple domains for patients-physical, sleep, cognitive, and emotional. Successful management of PCS requires a multi-disciplinary and individualized approach. There remains a significant need for further research, specifically looking into the outcomes and effective interventions in pediatric PCS.
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