Psychiatric treatment outcome following traumatic brain injury

Traumatic Brain Injury History Among Individuals Using Mental Health and Addictions Services: A Scoping Review

OBJECTIVE

Traumatic brain injury (TBI) has been increasingly linked in population research to psychiatric problems as well as substance use and related harms, suggesting that individuals with TBI may also present more frequently to mental health and addictions (MHA) services. Little is known, however, about TBI history among MHA service users. The objectives of this review were to understand (i) the prevalence of TBI history among MHA service users; (ii) how TBI history is identified in MHA service settings; and (iii) predictors or outcomes of TBI that have been reported in MHA service users.

METHODS

A scoping review was conducted in accordance with PRISMA Scoping Review Extension guidelines. A search for relevant literature was conducted in MEDLINE, PsycINFO, SPORTDiscus, CINAHL, and Embase as well as various gray literature sources.

RESULTS

Twenty-eight relevant studies were identified. TBI was defined and operationalized heterogeneously between studies, and TBI history prevalence rates ranged considerably among the study samples. The included studies used varied methods to identify TBI history in MHA settings, such as clinical chart audits, single-item questions, or structured questionnaires (eg, Brain Injury Screening Questionnaire or Ohio State University TBI Identification Method). TBI history was most consistently associated with indicators of more severe substance use problems and mental health symptoms as well as increased aggression or risk to others. Studies reported less consistent findings regarding the relationship of TBI to physical health, cognitive impairment, functioning, risk to self, and type of psychiatric diagnosis.

CONCLUSION

Screening for TBI history in MHA settings may contribute important information for risk assessment and care planning. However, to be clinically useful, assessment of TBI history will require consistent operationalization of TBI as well as use of validated screening methods.

Preinjury employment status as a risk factor for symptomatology and disability in mild traumatic brain injury: A TRACK-TBI analysis

BACKGROUND

Preinjury employment status may contribute to disparity, injury risk, and recovery patterns following mild traumatic brain injury (MTBI).

OBJECTIVE

To characterize associations between preinjury unemployment, prior comorbidities, and outcomes following MTBI.

METHODS

MTBI patients from TRACK-TBI Pilot with complete six-month outcomes were extracted. Preinjury unemployment, comorbidities, injury factors, and intracranial pathology were considered. Multivariable regression was performed for employment and outcomes, correcting for demographic and injury factors. Mean-differences (B) and 95% CIs are reported. Statistical significance was assessed at p < 0.05.

RESULTS

162 MTBI patients were aged 39.8±15.4-years and 24.6% -unemployed. Unemployed patients demonstrated increased psychiatric comorbidities (45.0% -vs.- 23.8%; p = 0.010), drug use (52.5% -vs.- 21.3%; p < 0.001), smoking (62.5% -vs.- 27.0%; p < 0.001), prior TBI (78.4% -vs.- 55.0%; p = 0.012), and lower education (15.0% -vs.- 45.1% college degree; p = 0.003). On multivariable analysis, unemployment associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended: B = - 0.50, 95% CI [- 0.88, - 0.11]), increased psychiatric disturbance (Brief Symptom Inventory-18: B = 6.22 [2.33, 10.10]), postconcussional symptoms (Rivermead Questionnaire: B = 4.91 [0.38, 9.44]), and post-traumatic stress disorder (PTSD Checklist-Civilian: B = 5.99 [0.76, 11.22]). No differences were observed for cognitive measures or satisfaction with life.

CONCLUSIONS

Unemployed patients are at risk for preinjury psychosocial comorbidities, poorer six-month functional recovery and increased psychiatric/postconcussional/PTSD symptoms. Resource allocation and return precautions should be implemented to mitigate and/or prevent the decline of at-risk patients.

Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations

INTRODUCTION

The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives.

METHOD

The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group.

RESULTS

458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury.

CONCLUSION

Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.

The efficacy of cognitive behavior therapy in the treatment of emotional distress after acquired brain injury

OBJECTIVE

To evaluate the efficacy of cognitive behavior therapy (CBT), adapted to meet the unique needs of individuals with acquired brain injury (ABI), and modified for both group and telephone delivery.

DESIGN

Matched-controlled trial, with multiple measurements across participants, including pretreatment baseline assessment plus posttreatment and 1-month follow-up.

SETTING

Outpatient community brain injury center.

PARTICIPANTS

Participants (N=20) with chronic ABI. Ten were assigned to the CBT treatment group and 10 to education control. All were experiencing significant emotional distress at the onset of the study.

INTERVENTION

Eleven sessions of CBT (or education control), including 1 introductory individual session plus 10 further sessions administered in either group format or by telephone. The CBT was designed to decrease psychologic distress and improve coping. Specific adaptations were made to the CBT in order to better accommodate individuals with cognitive difficulties.

MAIN OUTCOME MEASURES

Primary outcome measures included the Symptom Checklist-90-Revised (SCL-90-R) and the Depression Anxiety Stress Scales (DASS-21). Secondary outcome measures included the Community Integration Questionnaire (CIQ) and the Ways of Coping Scale, Revised.

RESULTS

Significant CBT treatment effects (in both group and telephone formats) were observed on the SCL-90-R and the DASS-21, whereas no significant effects were observed in the education control group. No significant effects of treatment were observed on the CIQ or Ways of Coping Scale, Revised.

CONCLUSIONS

Results suggest that adapted CBT-administered by telephone or in a face-to-face group setting-can significantly improve emotional well-being in chronic ABI.

Traumatic brain injury and mental health among two American Indian populations

OBJECTIVES

Describes prevalence of traumatic brain injury (TBI) and associated neuropsychiatric problems among two American Indian (AI) communities.

DESIGN

Analysis of cross-sectional epidemiological data.

SETTING

A Southwest (SW) and 2 Northern Plains (NP) AI reservations.

PARTICIPANTS

AI tribal members (N=2687; 394 with history of TBI and 2293 noninjured comparisons) aged 15 to 54.

OUTCOME MEASURES

Mood or anxiety disorders present more than 1 year after injury.

RESULTS

Prevalences were high (>20% in males; >10% in females) in these populations. Associations between TBI and disorders meeting Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria were strong in the SW community (adjusted odds ratio [OR]=2.4; 95% confidence interval [CI]=1.5-3.8), less so in the NP community (adjusted OR=1.4; 95% CI=0.9-2.2).

CONCLUSIONS

TBI is prevalent among AIs and is associated with increased OR of neuropsychiatric difficulties. This association may vary between tribes, though no interaction effect was found. AIs with TBI may require more thorough psychiatric screening to promote healthier outcomes.

Psychological and Neuropsychological Integration in Multidisciplinary Pain Management After TBI

The intersection of traumatic brain injury and posttraumatic chronic pain poses a significant challenge for the health practitioner. Effective intervention requires psychological and neuropsychological evaluation, multidisciplinary teamwork, and an understanding of a wide range of pain disorders and their relationship to traumatic brain injury. Assessment must include documentation of both current functioning and premorbid history. Pain interacts with cognitive impairment, mood and anxiety disorders, dysinhibition syndromes, and personality disorders, posing significant diagnostic dilemmas and treatment challenges. Coordinated care requires multiple, ongoing interventions from a variety of specialists. Patient involvement, focusing on internal locus of control, mediates successful treatment.