1
|
Trivedi C, Reddy P, Rizvi A, Husain K, Brown K, Mansuri Z, Nabi M, Jain S. Traumatic Brain Injury and Risk of Schizophrenia and Other Non-mood Psychotic Disorders: Findings From a Large Inpatient Database in the United States. Schizophr Bull 2024; 50:924-930. [PMID: 38639321 PMCID: PMC11283186 DOI: 10.1093/schbul/sbae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) is linked with an increased risk of schizophrenia and other non-mood psychotic disorders (psychotic disorders), but the prevalence and contributing factors of these psychiatric conditions post-TBI remain unclear. This study explores this link to identify key risk factors in TBI patients. METHODS We used the 2017 National Inpatient Sample dataset. Patients with a history of TBI (n = 26 187) were identified and matched 1:1 by age and gender to controls without TBI (n = 26 187). We compared clinical and demographic characteristics between groups. The association between TBI and psychotic disorders was explored using the logistic regression analysis, and results were presented as Odds ratio (OR) and 95% confidence interval (CI). RESULTS Psychotic disorders were significantly more prevalent in TBI patients (10.9%) vs controls (4.7%) (P < .001). Adjusted odds of psychotic disorders were 2.2 times higher for TBI patients (95% CI 2.05-2.43, P < .001). Male TBI patients had higher psychotic disorders prevalence than females (11.9% vs 8.4%). Younger age, bipolar disorder, anxiety disorders, substance abuse, personality disorders, and intellectual disability are associated with an increased risk of psychotic disorders in men. CONCLUSION Our study found that hospitalized TBI patients had 2.2 times higher odds of Schizophrenia non-mood psychotic disorder, indicating an association. This highlights the need for early screening of psychotic disorders and intervention in TBI patients, calling for more research.
Collapse
Affiliation(s)
- Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA
| | - Preetam Reddy
- Department of Psychiatry, Baptist Health-UAMS Medical Education Program, North Little Rock, AR, USA
| | - Abid Rizvi
- Department of Behavioral Medicine and Psychiatry West Virginia University, Morgan Town, WV, USA
| | - Karrar Husain
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA
| | - Kimberly Brown
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Mahamudun Nabi
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA
| | - Shailesh Jain
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA
| |
Collapse
|
2
|
Li LM, Carson A, Dams-O'Connor K. Psychiatric sequelae of traumatic brain injury - future directions in research. Nat Rev Neurol 2023; 19:556-571. [PMID: 37591931 DOI: 10.1038/s41582-023-00853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person's sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.
Collapse
Affiliation(s)
- Lucia M Li
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
3
|
Ergelen M, Yalçın M, Gıynaş FF, Kurnaz S, Usta Saglam NG. Cannabis use and first onset Schizophrenia-like psychosis after traumatic brain injury in a patient with intracranial bullet. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2173091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Mine Ergelen
- Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Murat Yalçın
- Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Fikret Ferzan Gıynaş
- Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Samet Kurnaz
- Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Nazife Gamze Usta Saglam
- Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
4
|
Muacevic A, Adler JR, Nielson JA. An Uncontrollable, Aggressive Patient at a Free-Standing Emergency Department. Cureus 2022; 14:e32742. [PMID: 36686138 PMCID: PMC9851284 DOI: 10.7759/cureus.32742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
We present the case of an aggressive male patient who was unable to be successfully sedated with conventional medications in the ED and ultimately required intubation to ensure the safety of the patient himself and the staff. After admission to the ICU, he was found to have atrophy of the frontal and bilateral lobes secondary to a traumatic brain injury (TBI) 19 years prior. Managing the patient required collaboration with the intensivist, hospitalist, and psychiatry and neurology teams for 10 months, and he was refused admission to multiple psychiatric facilities due to safety concerns because of his high level of aggression and unpredictability. An out-of-state, high-security facility eventually accepted the patient. The second challenge was finding a highly trained medical team willing to transport the patient. This case illustrates the difficulty and safety concerns with regard to managing an aggressive patient with previous TBI when the commonly used medications do not produce the desired effect. A literature search did not reveal a standard protocol or consensus on managing these types of patients in emergent situations.
Collapse
|
5
|
Funayama M, Nakagawa Y, Nakajima A, Kawashima H, Matsukawa I, Takata T, Kurose S. Apathy Level, Disinhibition, and Psychiatric Conditions Are Related to the Employment Status of People With Traumatic Brain Injury. Am J Occup Ther 2022; 76:23217. [PMID: 35226063 DOI: 10.5014/ajot.2022.047456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE An understanding of the potential prognostic factors as they relate to the employment status of people with traumatic brain injury (TBI) is necessary so that occupational therapy practitioners can provide the most effective treatment. OBJECTIVE To examine the impact of apathy, disinhibition, and psychiatric conditions on employment status after TBI. DESIGN An observational study conducted from March 2015 to March 2020. SETTING Cognitive dysfunction clinics associated with two general hospitals in Japan. PARTICIPANTS Japanese people of working age (N = 110, ages 18-65 yr) with TBI. Outcomes and Measures: As an outcome indicator, each participant's employment status was rated on a 3-point scale (i.e., 3 = regular employment, 2 = welfare employment [employed as a person with disabilities or undergoing vocational training in the Japanese welfare employment system, for which a worker is paid under either system], 1 = unemployment). Psychiatric, neuropsychological, and physical assessments were measured as explanatory variables. The impact of various factors on employment status was investigated using linear discriminant regression analysis. RESULTS The level of apathy, disinhibition, and incidence of psychiatric conditions after TBI, as well as age and years postinjury, were related to employment status. Conclusion and Relevance: Although this is a cross-sectional study, interventions for apathy and disinhibition, as well as management of psychiatric conditions, are recommended to help improve employment status among people with TBI. What This Article Adds: The employment status of people with TBI is related more to apathy, disinhibition, and psychiatric conditions than to intelligence, memory function, or executive function.
Collapse
Affiliation(s)
- Michitaka Funayama
- Michitaka Funayama, PhD, MD, is Doctor, Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan;
| | - Yoshitaka Nakagawa
- Yoshitaka Nakagawa, MS, is Speech-Language Pathologist, Department of Rehabilitation, Edogawa Hospital, Higashikoiwa, Edogawa-Ward, Tokyo, Japan
| | - Asuka Nakajima
- Asuka Nakajima is Speech-Language Pathologist, Department of Rehabilitation, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Hiroaki Kawashima
- Hiroaki Kawashima is Speech-Language Pathologist, Department of Rehabilitation, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Isamu Matsukawa
- Isamu Matsukawa, OTR/L, is Occupational Therapist, Department of Rehabilitation, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Taketo Takata
- Taketo Takata, MD, is Doctor, Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Shin Kurose
- Shin Kurose, MD, is Doctor, Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| |
Collapse
|
6
|
Cao M, Halperin JM, Li X. Abnormal Functional Network Topology and Its Dynamics during Sustained Attention Processing Significantly Implicate Post-TBI Attention Deficits in Children. Brain Sci 2021; 11:brainsci11101348. [PMID: 34679412 PMCID: PMC8533973 DOI: 10.3390/brainsci11101348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Traumatic brain injury (TBI) is highly prevalent in children. Attention deficits are among the most common and persistent post-TBI cognitive and behavioral sequalae that can contribute to adverse outcomes. This study investigated the topological properties of the functional brain network for sustained attention processing and their dynamics in 42 children with severe post-TBI attention deficits (TBI-A) and 47 matched healthy controls. Functional MRI data during a block-designed sustained attention task was collected for each subject, with each full task block further divided into the pre-, early, late-, and post-stimulation stages. The task-related functional brain network was constructed using the graph theoretic technique. Then, the sliding-window-based method was utilized to assess the dynamics of the topological properties in each stimulation stage. Relative to the controls, the TBI-A group had significantly reduced nodal efficiency and/or degree of left postcentral, inferior parietal, inferior temporal, and fusiform gyri and their decreased stability during the early and late-stimulation stages. The left postcentral inferior parietal network anomalies were found to be significantly associated with elevated inattentive symptoms in children with TBI-A. These results suggest that abnormal functional network characteristics and their dynamics associated with the left parietal lobe may significantly link to the onset of the severe post-TBI attention deficits in children.
Collapse
Affiliation(s)
- Meng Cao
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA;
| | - Jeffery M. Halperin
- Department of Psychology, Queens College, City University of New York, New York, NY 11367, USA;
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA;
- Correspondence: ; Tel.: +1-973-596-5880
| |
Collapse
|
7
|
Pototskiy E, Dellinger JR, Bumgarner S, Patel J, Sherrerd-Smith W, Musto AE. Brain injuries can set up an epileptogenic neuronal network. Neurosci Biobehav Rev 2021; 129:351-366. [PMID: 34384843 DOI: 10.1016/j.neubiorev.2021.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
Development of epilepsy or epileptogenesis promotes recurrent seizures. As of today, there are no effective prophylactic therapies to prevent the onset of epilepsy. Contributing to this deficiency of preventive therapy is the lack of clarity in fundamental neurobiological mechanisms underlying epileptogenesis and lack of reliable biomarkers to identify patients at risk for developing epilepsy. This limits the development of prophylactic therapies in epilepsy. Here, neural network dysfunctions reflected by oscillopathies and microepileptiform activities, including neuronal hyperexcitability and hypersynchrony, drawn from both clinical and experimental epilepsy models, have been reviewed. This review suggests that epileptogenesis reflects a progressive and dynamic dysfunction of specific neuronal networks which recruit further interconnected groups of neurons, with this resultant pathological network mediating seizure occurrence, recurrence, and progression. In the future, combining spatial and temporal resolution of neuronal non-invasive recordings from patients at risk of developing epilepsy, together with analytics and computational tools, may contribute to determining whether the brain is undergoing epileptogenesis in asymptomatic patients following brain injury.
Collapse
Affiliation(s)
- Esther Pototskiy
- Department of Anatomy & Pathology, Eastern Virginia Medical School, Department of Pathology, Norfolk, Virginia, USA; College of Sciences, Old Dominion University, Norfolk, Virginia
| | - Joshua Ryan Dellinger
- Department of Anatomy & Pathology, Eastern Virginia Medical School, Department of Pathology, Norfolk, Virginia, USA
| | - Stuart Bumgarner
- Department of Anatomy & Pathology, Eastern Virginia Medical School, Department of Pathology, Norfolk, Virginia, USA
| | - Jay Patel
- Department of Anatomy & Pathology, Eastern Virginia Medical School, Department of Pathology, Norfolk, Virginia, USA
| | - William Sherrerd-Smith
- Department of Anatomy & Pathology, Eastern Virginia Medical School, Department of Pathology, Norfolk, Virginia, USA
| | - Alberto E Musto
- Department of Anatomy & Pathology, Eastern Virginia Medical School, Department of Pathology, Norfolk, Virginia, USA; Department of Neurology, Eastern Virginia Medical School, Department of Pathology, Norfolk, Virginia, USA.
| |
Collapse
|
8
|
Bray MJC, Sharma B, Cottrelle's J, Peters ME, Bayley M, Green REA. Hippocampal atrophy is associated with psychotic symptom severity following traumatic brain injury. Brain Commun 2021; 3:fcab026. [PMID: 33977261 PMCID: PMC8098106 DOI: 10.1093/braincomms/fcab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Psychosis is a rare, but particularly serious sequela of traumatic brain injury. However, little is known as to the neurobiological processes that may contribute to its onset. Early evidence suggests that psychotic symptom development after traumatic brain injury may co-occur with hippocampal degeneration, invoking the possibility of a relationship. Particularly regarding the hippocampal head, these degenerative changes may lead to dysregulation in dopaminergic circuits, as is reported in psychoses due to schizophrenia, resulting in the positive symptom profile typically seen in post-injury psychosis. The objective of this study was to examine change in hippocampal volume and psychotic symptoms across time in a sample of moderate-to-severe traumatic brain injury patients. We hypothesized that hippocampal volume loss would be associated with increased psychotic symptom severity. From a database of n = 137 adult patients with prospectively collected, longitudinal imaging and neuropsychiatric outcomes, n = 24 had complete data at time points of interest (5 and 12 months post-traumatic brain injury) and showed increasing psychotic symptom severity on the Personality Assessment Inventory psychotic experiences subscale of the schizophrenia clinical scale across time. Secondary analysis employing stepwise regression with hippocampal volume change (independent variable) and Personality Assessment Inventory psychotic symptom change (dependent variable) from 5 to 12 months post-injury was conducted including age, sex, marijuana use, family history of schizophrenia, years of education and injury severity as control variables. Total right hippocampal volume loss predicted an increase in the Personality Assessment Inventory psychotic experiences subscale (F(1, 22) = 5.396, adjusted R2 = 0.161, P = 0.030; β = −0.017, 95% confidence interval = −0.018, −0.016) as did volume of the right hippocampal head (F(1, 22) = 5.764, adjusted R2 = 0.172, P = 0.025; β = −0.019, 95% confidence interval = −0.021, −0.017). Final model goodness-of-fit was confirmed using k-fold (k = 5) cross-validation. Consistent with our hypotheses, the current findings suggest that hippocampal degeneration in the chronic stages of moderate-to-severe traumatic brain injury may play a role in the delayed onset of psychotic symptoms after traumatic brain injury. These findings localized to the right hippocampal head are supportive of a proposed aetiological mechanism whereby atrophy of the hippocampal head may lead to the dysregulation of dopaminergic networks following traumatic brain injury; possibly accounting for observed clinical features of psychotic disorder after traumatic brain injury (including prolonged latency period to symptom onset and predominance of positive symptoms). If further validated, these findings may bear important clinical implications for neurorehabilitative therapies following traumatic brain injury.
Collapse
Affiliation(s)
- Michael J C Bray
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.,The KITE Research Institute-University Health Network, Toronto, ON M5G 2A2, Canada
| | - Bhanu Sharma
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.,The KITE Research Institute-University Health Network, Toronto, ON M5G 2A2, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Julia Cottrelle's
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Mark Bayley
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.,The KITE Research Institute-University Health Network, Toronto, ON M5G 2A2, Canada
| | - Robin E A Green
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.,The KITE Research Institute-University Health Network, Toronto, ON M5G 2A2, Canada
| |
Collapse
|
9
|
Merritt J, Tanguturi Y, Fuchs C, Cundiff AW. Medical Etiologies of Secondary Psychosis in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2020; 29:29-42. [PMID: 31708051 DOI: 10.1016/j.chc.2019.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is an updated review of child and adolescent somatic disorders associated with psychosis/psychotic symptoms, organized into neurologic, infectious, genetic, inborn errors of metabolism, autoimmune, rheumatologic, endocrine, nutritional, metabolic, and iatrogenic categories. When possible clinical manifestations or types of psychotic symptoms and proposed neuropathogenesis causing the neuropsychiatric symptoms are included. In some cases, the psychiatric symptoms may be the first presentation of the disease. The authors hope that this review will aid child and adolescent psychiatrists in considering alternative etiologies of youth presenting with psychosis and encourage appropriate physical examination, history, and further work-up when suspected.
Collapse
Affiliation(s)
- Jessica Merritt
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Yasas Tanguturi
- Department of Psychiatry, Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - Catherine Fuchs
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Allyson Witters Cundiff
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA.
| |
Collapse
|
10
|
Polich G, Iaccarino MA, Zafonte R. Psychopharmacology of traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:253-267. [PMID: 31727216 DOI: 10.1016/b978-0-444-64012-3.00015-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The pathophysiology of traumatic brain injury (TBI) can be highly variable, involving functional and/or structural damage to multiple neuroanatomical networks and neurotransmitter systems. This wide-ranging potential for physiologic injury is reflected in the diversity of neurobehavioral and neurocognitive symptoms following TBI. Here, we aim to provide a succinct, clinically relevant, up-to-date review on psychopharmacology for the most common sequelae of TBI in the postacute to chronic period. Specifically, treatment for neurobehavioral symptoms (depression, mania, anxiety, agitation/irritability, psychosis, pseudobulbar affect, and apathy) and neurocognitive symptoms (processing speed, attention, memory, executive dysfunction) will be discussed. Treatment recommendations will reflect general clinical practice patterns and the research literature.
Collapse
Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.
| |
Collapse
|
11
|
Abstract
Vision impairment and blindness arise both as a cause, and a consequence, of poverty. Achievement of the United Nations Sustainable Development Goals in providing universal access and equity in eye care, both within and between among countries, remains challenging. A severe shortage of eye care providers is creating unnecessary blindness and vision impairment in developing communities worldwide. Education and training develops and strengthens the capacity of emerging nations to contribute to global eye health and the World Health Organization Development Goals in an effective and sustainable way. Although relative to other medical professions, adoption of simulation in ophthalmic training has been relatively slow, simulation potentially offers reduced training costs, increased accessibility, objective measurement of training outcomes, and improvements in patient safety during and after clinician training, all of which can help address the global burden of vision impairment and blindness. Simulation training offers advantages over apprenticeship models, the traditional mode of transferring knowledge and skills in medicine and health, which suffers from imperfect transference due to inherent biases, heuristic and idiosyncratic expectations of experts, and subjective measures of outcomes. Simulation does not completely do away with these confounders because it is made to fit into established curricula, making it difficult to measure effectiveness of the simulation in isolation. The power of simulation training for resource-limited regions and countries is immense in offering cost-effective training in-country; however, it is important that any such tools are developed within the context of the limitations in situ.
Collapse
Affiliation(s)
- Judith L Flanagan
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Neilsen De Souza
- Brien Holden Vision Foundation, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Heads Up: The Presentation of Schizoaffective Disorder in an Elite College Soccer Player with Prior Concussion. Harv Rev Psychiatry 2018; 25:302-310. [PMID: 29117025 DOI: 10.1097/hrp.0000000000000147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Albrecht JS, O'Hara LM, Moser KA, Mullins CD, Rao V. Perception of Barriers to the Diagnosis and Receipt of Treatment for Neuropsychiatric Disturbances After Traumatic Brain Injury. Arch Phys Med Rehabil 2017; 98:2548-2552. [PMID: 28688786 DOI: 10.1016/j.apmr.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/30/2017] [Accepted: 06/03/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore perceptions of barriers and facilitators to the diagnosis and receipt of treatment for neuropsychiatric disturbances (NPDs) after traumatic brain injury (TBI). DESIGN Qualitative study using semistructured interviews and focus groups. SETTING A clinic specializing in the treatment of TBI NPDs, an urban trauma center, and a large urban academic hospital. PARTICIPANTS A sample (N=33) of health care providers (n=10) who treat individuals with TBI, persons with TBI (n=18), and caregivers (n=5). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Topic guides for the interviews and focus groups were guided by previous literature, clinical experience, and the goals of the project and focused on the 3 most common TBI NPDs: depression, anxiety, and posttraumatic stress disorder. The interviews and focus groups were audio-recorded and transcribed verbatim. We performed a conventional content analysis on the transcripts and grouped concepts into overall themes, incorporating feedback from stakeholders. RESULTS Patient education, insurance, provider type, time since TBI, caregiver support, and recognition or screening for TBI NPDs were the most frequently mentioned barriers or facilitators to the diagnosis and treatment of TBI NPDs by both interview and focus group participants. We grouped these and other frequently mentioned concepts into 3 broad themes: education, access, and support. Each of these themes is explored in depth and supported with direct quotations. CONCLUSIONS This study explored patient, caregiver, and health care provider and identified barriers and facilitators to the diagnosis and receipt of treatment for TBI NPDs. Barriers included poor provider education on TBI NPDs and limited access to care due to lack of insurance, transportation, and income. Facilitators included patient education on TBI NPDs and strong caregiver support. Future studies should develop and pilot interventions aimed at quality of care that address the identified barriers and facilitators.
Collapse
Affiliation(s)
- Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
| | - Lyndsay M O'Hara
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Kara A Moser
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Vani Rao
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
14
|
Abstract
Although altered consciousness and other neurologic manifestations are frequently seen in hypertensive encephalopathy, behavioral and psychotic symptoms are rarely seen. We describe a patient with no previous psychiatric history who was admitted for hypertensive crisis. A few days after admission, his blood pressure remained uncontrolled and he started to exhibit episodes of confusion, agitation, and psychosis. During one particular episode, he overcame multiple staff members and physical restraints to bite off two of his fingers without any signs of pain. Brain computed tomography (CT) was notable for possible posterior cerebral and cerebellar edema. His confusion and agitation gradually resolved with successful blood pressure management. This is the first reported case of extreme, agitated behaviors and auditory hallucinations in a patient with hypertensive crisis.
Collapse
Affiliation(s)
| | - Saba Syed
- Psychiatry, Olive View, UCLA Medical Center
| |
Collapse
|
15
|
Abstract
Violence is a serious public health issue across the world. This article assists clinicians in understanding the most up-to-date literature regarding structural and functional brain theories related to risk of violence. In this article, we review anatomic regions of the brain that have been implicated in violence and associated personality constructs associated with violence. We discuss different imaging techniques that have been used to uncover abnormal brain volume, associations, and functions throughout the brain in samples with violence history or risk. Finally, we discuss implications of these findings both for treatment considerations and future research directions.
Collapse
Affiliation(s)
- Delaney Smith
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, 1670 Upham Drive, Suite 130, Columbus, OH 43214, USA; Twin Valley Behavioral Healthcare, 2200 West Broad Street, Columbus, OH 43223, USA.
| | - Riley Smith
- Department of Physical Medicine and Rehabilitation, Wayne State University/Beaumont, 18181 Oakwood Boulevard, Suite 411, Dearborn, MI 48124, USA
| | - Douglas Misquitta
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, 1670 Upham Drive, Suite 130, Columbus, OH 43214, USA
| |
Collapse
|
16
|
Cieslak K, Pato M, Buckley P, Pato C, Sobell JL, Medeiros H, Zhao Y, Ahn H, Malaspina D. Traumatic brain injury and bipolar psychosis in the Genomic Psychiatry Cohort. Am J Med Genet B Neuropsychiatr Genet 2016. [PMID: 26224022 DOI: 10.1002/ajmg.b.32350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Approximately three million individuals in the United States sustain traumatic brain injury (TBI) every year, with documented impact on a range of neurological and psychiatric disturbances including mania, depression, and psychosis. Identification of subsets of individuals that may demonstrate increased propensity for posttraumatic symptoms and who may share genetic vulnerabilities for gene-environment interactions can enhance efforts to understand, predict, and prevent these phenomena. A sample of 11,489 cases from the Genomic Psychiatry Cohort (GPC), a NIMH-managed data repository for the investigation of schizophrenia and bipolar disorder, was used for this study. Cases were excluded if TBI was deemed causal to their mental illness. A k-means clustering algorithm was used to probe differences between schizophrenia and bipolar disorder associated with variables including onset age, hallucinations, delusions, head injury, and TBI. Cases were separated into an optimum number of seven clusters, with two clusters including all cases with brain injury. Bipolar disorder with psychosis and TBI were significantly correlated in one cluster in which 72% of cases were male and 99.2% sustained head injury. This cluster also carried the longest average period of unconsciousness. This study demonstrates an association of TBI with psychosis in a subset of bipolar cases, suggesting that traumatic stressors may have the ability to impact gene expression in a vulnerable population, and/or there is a heightened occurrence of TBI in individuals with underlying psychosis. Further studies should more closely examine the interplay between genetic variation in bipolar disorder and susceptibility to psychosis following TBI. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Kristina Cieslak
- Department of Psychiatry, New York University School of Medicine, Social, and Psychiatric Initiative (InSPIRES), New York
| | - Michelle Pato
- Department of Psychiatry, Keck School of Medicine of USC, Los Angeles, California
| | - Peter Buckley
- Department of Psychiatry, Medical College of Georgia at Georgia Reagents University, Augusta, Georgia
| | - Carlos Pato
- Department of Psychiatry, Keck School of Medicine of USC, Los Angeles, California
| | - Janet L Sobell
- Department of Psychiatry, Keck School of Medicine of USC, Los Angeles, California
| | - Helena Medeiros
- Department of Psychiatry, Keck School of Medicine of USC, Los Angeles, California
| | - Yuan Zhao
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Hongshik Ahn
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | | | - Dolores Malaspina
- Department of Psychiatry, New York University School of Medicine, Social, and Psychiatric Initiative (InSPIRES), New York
| |
Collapse
|
17
|
Rabner J, Gottlieb S, Lazdowsky L, LeBel A. Psychosis following traumatic brain injury and cannabis use in late adolescence. Am J Addict 2016; 25:91-3. [PMID: 26849855 DOI: 10.1111/ajad.12338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/04/2016] [Accepted: 01/18/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Both cannabis and traumatic brain injury (TBI) pose risks on the developing brain, including a potential increased vulnerability for developing psychosis. Recent reports detail an upward trend in both adolescent cannabis use and the concentration of THC, the most potent psychoactive component in cannabis. Similarly, it is estimated that 1.7 million Americans incur a TBI each year. Previously trivialized as a minor nuisance, attitudes towards TBIs are changing as researchers and the public recognize TBIs' possible long-lasting sequelae. CASE REPORT Two cases are presented of adolescent patients with histories of TBI and self-reported heavy, recreational cannabis use who developed symptoms of psychosis. DISCUSSION Similar neuronal signaling pathways involved in cannabis ingestion and TBI recovery, specifically CB1 receptors of the endocannabinoid system, as well as the allostatic load model provide context for the two presented cases. Given the cases and theories presented, we believe that cannabis use may act as a neurological stressor and risk factor for psychosis outweighing its possible benefits as a therapeutic solution for pain in late adolescent and young adult populations. SIGNIFICANCE The presented cases provide further support for the compounded risk of developing psychosis following TBI and cannabis use.
Collapse
Affiliation(s)
- Jonathan Rabner
- Pediatric Headache Program, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Waltham, Massachusetts
| | - Sarah Gottlieb
- Pediatric Headache Program, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Waltham, Massachusetts
| | - Lori Lazdowsky
- Pediatric Headache Program, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Waltham, Massachusetts
| | - Alyssa LeBel
- Pediatric Headache Program, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Waltham, Massachusetts
| |
Collapse
|
18
|
Stéfan A, Mathé JF. What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices. Ann Phys Rehabil Med 2016; 59:5-17. [DOI: 10.1016/j.rehab.2015.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022]
|
19
|
Zgaljardic DJ, Seale GS, Schaefer LA, Temple RO, Foreman J, Elliott TR. Psychiatric Disease and Post-Acute Traumatic Brain Injury. J Neurotrauma 2015; 32:1911-25. [DOI: 10.1089/neu.2014.3569] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dennis J. Zgaljardic
- Transitional Learning Center, Galveston, Texas
- University of Texas Medical Branch, Galveston, Texas
| | | | | | | | | | | |
Collapse
|