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Wender CLA, Ray LN, Sandroff BM, Krch D. Exercise as a behavioral approach to improve mood in persons with traumatic brain injury. PM R 2024; 16:919-931. [PMID: 37874561 DOI: 10.1002/pmrj.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/12/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
Mood disturbance is a common, long-term, negative consequence of traumatic brain injury (TBI) that is insufficiently addressed by most traditional treatment modalities. A large body of evidence supports the efficacy of exercise training (ET) to broadly improve mood, as measured most often by the Profile of Mood States (POMS). However, this behavioral approach is not used nearly enough in the TBI population, and when it is, mood is rarely measured. This scoping review will evaluate the use of POMS as a mood measure in TBI research and to establish a rationale for using ET as a behavioral approach to broadly improve mood in persons with TBI.
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Affiliation(s)
- Carly L A Wender
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - LaShawnna N Ray
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Brian M Sandroff
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
- Center for Neuropsychology & Neuroscience Research, Kessler Foundation, West Orange, New Jersey, USA
| | - Denise Krch
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
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2
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Barua U, Ahrens J, Shao R, MacKenzie H, Wolfe D, Sequeira K, Teasell R, Loh E, Mehta S. Cognitive behavioral therapy for managing depressive and anxiety symptoms after brain injury: a meta-analysis. Brain Inj 2024; 38:227-240. [PMID: 38318855 DOI: 10.1080/02699052.2024.2309264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Individuals with traumatic brain injury (TBI) are at increased risk of depression and anxiety, leading to impaired recovery. While cognitive-behavioral therapy (CBT) addresses anxiety and depression maintenance factors, its efficacy among those with TBI has not been clearly demonstrated. This review aims to bridge this gap in the literature. METHODS Several databases, including Medline, PsycInfo and EMBASE, were used to identify studies published between 1990 and 2021. Studies were included if: (1) trials were randomized controlled trials (RCT) involving CBT-based intervention targeting anxiety and/or depression; (2) participants experienced brain injury at least 3-months previous; (3) participants were ≥18 years old. An SMD ± SE, 95% CI and heterogeneity were calculated for each outcome. RESULTS Thirteen RCTs were included in this meta-analysis. The pooled-sample analyses suggest that CBT interventions had small immediate post-treatment effects on reducing depression (SMD ± SE: 0.391 ± 0.126, p < 0.005) and anxiety (SMD ± SE: 0.247 ± 0.081, p < 0.005). Effects were sustained at a 3-months follow-up for depression. A larger effect for CBT was seen when compared with supportive therapy than control. Another sub-analysis found that individualized CBT resulted in a slightly higher effect compared to group-based CBT. CONCLUSION This meta-analysis provides substantial evidence for CBT in managing anxiety and depression post-TBI.
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Affiliation(s)
- Ujjoyinee Barua
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Jessica Ahrens
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Richard Shao
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Heather MacKenzie
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Dalton Wolfe
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Keith Sequeira
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Robert Teasell
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Eldon Loh
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Swati Mehta
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
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Giovanis E, Menon M, Perali F. Disability specific equivalence scales: a case-control approach applied to the cost of acquired brain injuries. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:643-672. [PMID: 35608742 DOI: 10.1007/s10754-022-09332-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
This study estimates the household costs resulting from acquired brain injuries in terms of a reduction in the standard of living. The application uses primary data collected in the Verona and Florence provinces of Italy integrating highly detailed health information with information about consumption, income, wealth, time-use and relational well-being describing the standard of living. In general, the estimates of disability costs in previous studies are obtained from survey data without a specific focus on individuals with disabilities but collect information on the general health status. In contrast, this study exploits highly detailed information on a sample of "cases" with a disability, whose intensity is measured by the highly precise European quality of life measure-5 domain-5 (EQ-5D) instrument, to be compared with a sample of "control" formed by households without disabled members. The disability scales have been estimated using a Structural Equation Modelling (SEM) based procedure. We then implement interpersonal comparisons on the health income dimension in a theoretically plausible way, testing the independence hypothesis of equivalence scales. Our study finds that on average disabled households need an additional amount of about €1800 per month to reach the same standard of livings as the non-disabled households corresponding to a scale of 1.78.
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Affiliation(s)
- Eleftherios Giovanis
- Faculty of Economics and Administrative Sciences, Department of International Trade and Business, İzmir Bakırçay University, Menemen, 35665, Izmir, Turkey.
| | - Martina Menon
- Department of Economics, University of Verona, Via Cantarane 24, 37129, Verona, Italy
| | - Federico Perali
- Department of Economics, University of Verona, Via Cantarane 24, 37129, Verona, Italy
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Dunne S, Williams GP, Bradbury C, Keyes T, Lane AR, Yang K, Ellison A. Uncovering the social determinants of brain injury rehabilitation. J Health Psychol 2023; 28:956-969. [PMID: 37026570 PMCID: PMC10466963 DOI: 10.1177/13591053231166263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Social determinants of health (SDH), such as social isolation and loneliness, are often more frequently experienced in brain injury survivors. The paper explores the personal experiences of loneliness among brain injury survivors during lockdown to negate health inequalities and improve rehabilitation for this population in the future. Twenty-four brain injury survivors participated in semi-structured interviews and questionnaires relating to loneliness, resilience and wellbeing. Three themes (the experience of loneliness, loneliness during the pandemic and loneliness after the pandemic) explored survivors' experiences of loneliness generally post-brain injury, but also chronicle how these feelings developed in lockdown and survivors' feelings regarding society returning to 'normal'. Future interventions should focus on reframing survivors' beliefs regarding societal expectations and minimise the pressure they experience to keep up with their peers physically and emotionally. Additionally, we recommend creating accessible peer support options for all brain injury survivors as an important step for alleviating loneliness.
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Affiliation(s)
- Stephen Dunne
- Northumbria University, UK
- NIHR Applied Research Collaboration North-East and North Cumbria, UK
| | | | | | | | | | | | - Amanda Ellison
- NIHR Applied Research Collaboration North-East and North Cumbria, UK
- Durham University, UK
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Al-Kader DA, Onyechi CI, Ikedum IV, Fattah A, Zafar S, Bhat S, Malik MA, Bheesham N, Qadar LT, Sajjad Cheema M. Depression and Anxiety in Patients With a History of Traumatic Brain Injury: A Case-Control Study. Cureus 2022; 14:e27971. [PMID: 36134081 PMCID: PMC9481205 DOI: 10.7759/cureus.27971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background The burden of psychiatric illness following a head injury may have implications on the disease prognosis. The present study evaluated the association of depression and anxiety with traumatic brain injury (TBI). Methods A case-control study was conducted in Karachi, Pakistan, from 2nd July 2021 and 30th January 2022, including individuals of age 18 and above of both genders, with or without a mild head trauma history, forming the case and control groups, respectively. Individuals with previous head trauma/congenital neurological dysfunction were excluded. A mental health assessment of the participants was carried out with two scales, the Generalized Anxiety Disorder-7 (GAD-7) scale and the Public Health Questionnaire-9 (PHQ-9) scale. Other parameters like age, gender, socioeconomic status, education status, and comorbidities were also documented. Results A total of 62 participants were enrolled with 31 cases and 31 controls. The majority were males aged between 18 and 39 years. About 29% of the patients with a history of mild TBI had moderate to severe depression while only 22.6% of them did not have depression or had minimal depression. We found that about 29.3% of patients with TBI had severe anxiety as compared to the only two healthy controls. The majority of the control group participants did not have anxiety. Conclusion Traumatic head injuries and their long-term side effects can predispose patients to a myriad of psychiatric comorbidities. In this study, we found definitive evidence that both anxiety and depression had a significantly higher incidence in cohorts that suffered from mild TBI. However, we recommend large-scale and multicenter studies in the future to explore these relationships more thoroughly and comprehensively.
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Roberts H, Ford TJ, Karl A, Reynolds S, Limond J, Adlam ALR. Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model. Front Hum Neurosci 2022; 16:835897. [PMID: 35754774 PMCID: PMC9218558 DOI: 10.3389/fnhum.2022.835897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose/Objective Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population. Method We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation. Results and Implications We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.
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Affiliation(s)
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Anke Karl
- Psychology, University of Exeter, Exeter, United Kingdom
| | - Shirley Reynolds
- Department of Psychology, University of Reading, Reading, United Kingdom
| | - Jenny Limond
- Psychology, University of Exeter, Exeter, United Kingdom
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Pettemeridou E, Constantinidou F. The cortical and subcortical substrates of quality of life through substrates of self-awareness and executive functions, in chronic moderate-to-severe TBI. Brain Inj 2022; 36:110-120. [DOI: 10.1080/02699052.2022.2034960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Eva Pettemeridou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
- Kios Innovation & Research Center of Excellence, University of Cyprus, Nicosia, Cyprus
| | - Fofi Constantinidou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
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Medeiros GC, Twose C, Weller A, Dougherty JW, Goes FS, Sair HI, Smith GS, Roy D. Neuroimaging correlates of depression after traumatic brain injury: A systematic review. J Neurotrauma 2022; 39:755-772. [PMID: 35229629 DOI: 10.1089/neu.2021.0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Depression is the most frequent neuropsychiatric complication after traumatic brain injury (TBI) and is associated with poorer outcomes. Neuroimaging has the potential to improve our understanding of the neural correlates of depression after TBI and may improve our capacity to accurately predict and effectively treat this condition. We conducted a systematic review of structural and functional neuroimaging studies that examined the association between depression after TBI, and neuroimaging measures. Electronic searches were conducted in four databases and were complemented by manual searches. In total, 2,035 citations were identified and, ultimately, 38 articles were included totaling 1,793 individuals (median [25%-75%] sample size of 38.5 (21.8-54.3) individuals). The most frequently used modality was structural magnetic resonance imaging (MRI) (n=17, 45%), followed by diffusion tensor imaging (n=11, 29%), resting-state functional MRI (n=10, 26%), task-based functional MRI (n=4, 8%), and positron emission tomography (n=2, 4%). Most studies (n=27, 71%) were cross-sectional. Overall, depression after TBI was associated with lower grey matter measures (volume, thickness, and/or density) and greater white matter damage. However, identification of specific brain areas was somewhat inconsistent. Findings that were replicated in more than one study included reduced grey matter in the rostral anterior cingulate cortex, prefrontal cortex and hippocampus, and damage in five white matter tracts (cingulum, internal capsule, superior longitudinal fasciculi, anterior, and posterior corona radiata). This systematic review found that the available data did not converge on a clear neuroimaging biomarker for depression after TBI. However, there are promising targets that warrant further study.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexandra Weller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John W Dougherty
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Banerjee M, Hegde S, Thippeswamy H, Kulkarni GB, Rao N. In search of the 'self': Holistic rehabilitation in restoring cognition and recovering the 'self' following traumatic brain injury: A case report. NeuroRehabilitation 2021; 48:231-242. [PMID: 33664160 DOI: 10.3233/nre-208017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Following mild-moderate traumatic brain injury (TBI), an individual experiences a range of emotional changes. It is often difficult for the patient to reconcile with their post-injury persona, and the memory of pre-injury personhood is particularly painful. Insight into one's cognitive deficits subsequent to injury can lead to an existential crisis and a sense of loss, including loss of self. OBJECTIVE Restoration of cognitive functions and reconciliation with loss of pre-traumatic personhood employing a holistic method of neuropsychological rehabilitation in a patient suffering from TBI. METHODS Ms. K.S, a 25-year-old female, presented with emotional disturbances following TBI. She reported both retrograde and anterograde amnesia. A multidimensional holistic rehabilitation was planned. Treatment addressed cognitive deficits through the basic functions approach. Cognitive behavioural methods for emotional regulation like diary writing helped reduce irritability and anger outbursts. Use of social media created new modes of memory activation and interactions. Compensatory strategies were used to recover lost skills, music-based attention training helped foster an individualised approach to the sense of one's body and self. RESULTS As a result of these differing strategies, changes were reflected in neuro-psychological tests, depression score and the patient's self-evaluation. This helped generate a coherent self-narrative. CONCLUSION Treatment challenges in such cases are increased due to patient's actual deficits caused by neuronal/biochemical changes. Innovative and multi-pronged rehabilitation strategies which involve everyday activities provided an answer to some of these problems. This method of rehabilitation may provide an optimistic context for future research.
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Affiliation(s)
- Meenakshi Banerjee
- Neuropsychology and Cognitive Neuroscience Centre, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shantala Hegde
- Neuropsychology and Cognitive Neuroscience Centre, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.,Associate Professor and Wellcome DBT India Alliance Intermediate Fellow, Clinical Neuropsychology and Cognitive Neuro Sciences Center, Music Cognition Laboratory, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.,Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Narasinga Rao
- Department of Surgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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Green SL, Gignac GE, Watson PA, Brosnan N, Becerra R, Pestell C, Weinborn M. Apathy and Depression as Predictors of Activities of Daily Living Following Stroke and Traumatic Brain Injuries in Adults: A Meta-Analysis. Neuropsychol Rev 2021; 32:51-69. [PMID: 33759039 DOI: 10.1007/s11065-021-09501-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
Apathy and depression are common sequelae of acquired brain injury (ABI). Apathy is a syndrome characterized by diminished motivation and purposeful behaviours. Depression is a mood disorder featuring sadness, worthlessness, anhedonia and suicidal ideation. Both are associated negatively with activities of daily living (ADL), the skills required to fulfil basic and complex physical needs. However, the current literature's results are inconsistent and based on relatively small sample sizes. Furthermore, the unique and combined effects of apathy and depression as predictors of ADL have not yet been estimated. This is important, as both may have implications for planning rehabilitation after an ABI. Consequently, we aimed to estimate the association between apathy, depression and ADL in the stroke and traumatic brain injured population via meta-analysis and meta-analytic path-analysis. Based on the meta-analyses (N = 1,166 to N = 1,389), we estimated the following statistically significant bivariate effects: depression and apathy (r = .53, 95% CI: .42/.63), depression and ADL (r = -.27, 95% CI: -.43/-.11), apathy and ADL (r = -.41, 95% CI: -.51/-.31). A meta-analytic mediation model found that depression had a significant indirect effect onto ADL (β = -.17, 95% CI: -.26/-.09), while apathy had a significant direct effect (β = -.34, 95% CI: -.48/-.19) onto ADL (model R2 = .16). We interpreted the results to suggest that apathy and depression may impact adversely on engagement with ADL in people with ABI, although the potential influence of depression on ADL may occur primarily through its influence on apathy. Thus, greater focus on apathy by practitioners may be merited in cases with ABI.
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Affiliation(s)
- Sarah L Green
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Gilles E Gignac
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Prue A Watson
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Nicky Brosnan
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Rodrigo Becerra
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Carmela Pestell
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Michael Weinborn
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
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McDonald S, Genova H. The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:235-260. [PMID: 34389120 DOI: 10.1016/b978-0-12-822290-4.00011-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
| | - Helen Genova
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
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Experiences of offenders with traumatic brain injury. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurpose:Traumatic brain injury is recognised as a significant and pervasive health issue among offender populations. Despite this, no qualitative research exists exploring the experiences and perceptions of offenders with TBI in prison.Methods:Qualitative interviews were conducted with male and female offenders housed in a UK prison. Interviews examined what participants felt led them to offend, experiences of incarceration, and post-release plans. Presence of TBI was assessed via the Brain Injury Screening Index. Data were analysed by means of inductive content analysis.Findings:Both male and female prisoners primarily attributed their incarceration to drugs and alcohol use, with males also referencing more issues with aggression, while mental illness and past abuse were more commonly mentioned among females. A lack of recognition for the possible role of TBI was noted, with several males describing themselves as ‘stupid’ or prone to making ‘poor lifestyle choices’. Both groups indicated a desire to return to education or work post-release.Conclusions:Despite significant rates of injury, there is a clear lack of understanding and consideration of the role of TBI in the behaviour and presentation of offenders. There is need for improved identification and education around TBI early in the criminal justice process.
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Lowe N, Crawley L, Wilson C, Waldron B. 'Lonely in my head': The experiences of loneliness in individuals with brain injury. Br J Health Psychol 2020; 26:444-463. [PMID: 33270325 DOI: 10.1111/bjhp.12481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/29/2020] [Indexed: 11/29/2022]
Abstract
PRIMARY OBJECTIVE This paper reports on the personal experiences of loneliness for individuals living with brain injury. RESEARCH DESIGN This is a qualitative research design, employing semi-structured interviews and subsequent contextualist thematic analysis. METHODS AND PROCEDURES Eleven clients (two female and nine male, aged between 27 and 63 years) with brain injury participated in semi-structured interviews. Thematic analysis was employed in the interpretation of the data. MAIN OUTCOMES AND RESULTS The interview data and subsequent analysis depicted three overarching themes in a healing process - 'Internal Loneliness', 'Healing the Cracks', and 'Visible with Cracks'. Participants described five factors which contribute to their feeling of loneliness: trauma, social isolation, concealment, rejection of part of self, and invisibility of their disability. The participants' accounts also detailed the necessity of a therapeutic intervention and relationship to deal with and address some of these issues. CONCLUSIONS This study highlights that processing the trauma, developing dialectical thinking, self-compassion, and a degree of self-acceptance assist in the movement of participants towards allowing themselves to be 'Visible with Cracks'. This allowance of self to be fully seen appears to serve an important function for reconnection with self and others. These results may help to inform brain injury rehabilitative care, through developing their understanding of the internal loneliness factors that may be influencing an individual's social isolation or social withdrawal.
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Affiliation(s)
- Niamh Lowe
- School of Psychology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | | | - Charlotte Wilson
- School of Psychology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
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Andrews PW, Maslej MM, Thomson Jr. JA, Hollon SD. Disordered doctors or rational rats? Testing adaptationist and disorder hypotheses for melancholic depression and their relevance for clinical psychology. Clin Psychol Rev 2020; 82:101927. [DOI: 10.1016/j.cpr.2020.101927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 01/13/2023]
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Nikova A, Dimitrov I. Brain Trauma Mortality Rate Score Scale (BTMRSS): Postmortem Evaluation of the Events. Korean J Neurotrauma 2020; 16:166-173. [PMID: 33163424 PMCID: PMC7607009 DOI: 10.13004/kjnt.2020.16.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Brain trauma and its burden is becoming a significant cause of permanent damage and deterioration. Prioritization at the place of the incident and calculation of mortality are leading factors for the final management, but all of them are obtained from living patients. When the autopsies are made there is no actual score system to guide the forensic scientists in their conclusions. Should all of the cadavers with traumatic brain injury (TBI) have been dead? Therefore, we aim to present a score system—brain trauma mortality score scale (BTMSS), aiming to evaluate postmortem the actual risk of mortality. Methods We established a score scale, which could be used on cadavers for the evaluation of the events. Afterwards, we applied this score scale on the reports of the cadavers who suffered blunt force TBI for a 10-year period of time between 2007 and 2016. Thereafter, the results were processed with SPSS version 25. Results The outcome showed that there is a significant difference between the scores of the cadavers who died at the place of the incident and those who died in hospital thus approving that the BTMSS works well, as well as the importance of level I trauma center. Conclusion Every score system could show something useful for the management of the TBIs. The solution and improvement in the outcome of the current study would be a level I trauma center with a qualified neurosurgical department.
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Affiliation(s)
- Alexandrina Nikova
- Department of Neurosurgery, “Evangelismos” General Hospital, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Ivaylo Dimitrov
- Department of Forensic Science and Toxicology, Regional Hospital “Stamen Iliev”, Montana, Bulgaria
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Predicting mood outcome following traumatic brain injury (TBI): PTA & demographic variables. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground and aims:Mood disturbance is frequent after traumatic brain injury (TBI), often assessed using the Hospital Anxiety and Depression Scale (HADS). Research supports a three-factor HADS structure (anxiety, depression, and psychomotor), although this has not been used to investigate demographic variables and mood outcome post-TBI. This study examined severity of TBI, demographic variables [age, gender, estimated premorbid IQ (EIQ), relationship status, employment status, socio-economic status (SES)], and mood outcome, using HADS factor scores from a large adult population sample in Tasmania.Method:HADS factor scores were calculated for an initial sample of 596 adults. The sample sizes varied according to those attending at 1, 6, 12 and 24 months post-TBI and the available data for each dependent variable.Results:Significantly higher anxiety, depression, and psychomotor scores were reported at most follow-ups by females, the middle-aged, and those with lower IQs. Longer post-traumatic amnesia (PTA) was associated with significantly greater mood problems. Occasional significant findings at earlier follow-ups for the factors were noted for those unemployed. Other variables were rarely significant. PTA, premorbid IQ, and Age were included in most Multiple Regression equations predicting outcome for the factors, with Gender included for Anxiety and depression at 6 months after injury.Conclusions:Key demographic variables and PTA severity relate to mood post-TBI, and contribute to predicting mood outcome. Differences in findings for the three factors support their use in clinical practice.
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Rowlands L, Coetzer R, Turnbull OH. Good things better? Reappraisal and discrete emotions in acquired brain injury. Neuropsychol Rehabil 2019; 30:1947-1975. [PMID: 31161878 DOI: 10.1080/09602011.2019.1620788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There has been substantial interest in emotion after acquired brain injury (ABI), but less attention paid to emotion regulation (ER). Research has focused primarily on the ER strategy of reappraisal for regulating negative emotions, without distinguishing between classes of emotion, and there has been no attempt at exploring these differences in patients with ABI. The present study explored components of reappraisal, across classes of emotion, and their associated neuropsychological mechanisms. Thirty-five patients with ABI and twenty-two matched healthy control participants (HCs) completed two questionnaires, a battery of cognitive tasks, and an emotion regulation task (the Affective Story Recall Reappraisal task). Results suggest that those with ABI take longer, and generate fewer reappraisals than HCs across several discrete emotions. Notably, their ability to decrease emotional intensity did not differ significantly to HCs for negative emotions, but findings suggest that their reappraisals are less effective when up-regulating neutral emotions to positive. Working memory was the only significant predictor of the total number of reappraisals generated, and the time taken to produce a first reappraisal. Implications of these findings are discussed in the context of neuropsychological rehabilitation, including the role of the relatives in implementing and reinforcing micro-interventions.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
| | - Rudi Coetzer
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
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18
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Wadhawan A, Stiller JW, Potocki E, Okusaga O, Dagdag A, Lowry CA, Benros ME, Postolache TT. Traumatic Brain Injury and Suicidal Behavior: A Review. J Alzheimers Dis 2019; 68:1339-1370. [DOI: 10.3233/jad-181055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Abhishek Wadhawan
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, USA
| | - John W. Stiller
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Neurology Consultation Service, Washington, DC, USA
- Maryland State Athletic Commission, Baltimore, MD, USA
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Olaoluwa Okusaga
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Aline Dagdag
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA
| | - Christopher A. Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodor T. Postolache
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA
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Hampson N, King L, Eriksson LM, Smee H. The effects of relaxation training on depression and anxiety in people living with long-term neurological conditions. Disabil Rehabil 2019; 42:2100-2105. [PMID: 30653375 DOI: 10.1080/09638288.2018.1554009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: The present study investigated the effects of a relaxation training program on self-reported depression and anxiety in participants living with long-term neurological conditions, including acquired brain injury, stroke, Parkinson's disease, and multiple sclerosis.Materials and methods: A five-session relaxation training program, plus a follow-up session was offered to people living with a long-term neurological condition as part of routine clinical practice, and was delivered in their own homes. A self-report measure (Hospital Anxiety and Depression Scale) was administered at the pre- and post-intervention time points and at follow-up, around 5 weeks after the final session. Participants also completed an individual assessment of change questionnaire at follow-up, reporting on subjective views of observed changes.Results: Statistically significant improvements were found on measures of both anxiety and depression following completion of the relaxation program. Scores at follow-up (mean = 5 weeks) revealed the improvement was maintained for anxiety, and there was further significant improvement for depression. Reliable change analyses from pre- to post-intervention demonstrated a clinically significant decrease in anxiety scores for 47% of participants and in depression scores for 30% of participants. No clinically significant increase in depression and anxiety was identified from pre- to post-intervention, and this was generally maintained at follow-up.Conclusion: Relaxation training is proposed as a clinically effective treatment for anxiety and depression in people living with long-term neurological conditions, which could in turn lead to better functional outcomes of neurorehabilitation. The program investigated here has additional benefits of being delivered in people's own homes, which overcomes barriers to attending hospital, and is consistent with trends towards home as opposed to hospital care. This program may also be less costly to administer as it can be delivered as part of a stepped-care program by therapy assistants under supervision from qualified staff, and encourages self-management over the longer term. Design limitations may reduce the generalisability of these findings, but are clinically encouraging and should stimulate further research.Implications for RehabilitationRelaxation training…• could be offered as an effective first-line intervention, as an alternative to medication to treat anxiety and depression to people living with Long-Term Neurological Conditionsis a self-management strategy which can be taught in people's own homes, if getting out of the house is difficultcan be delivered as a stepped-care intervention via therapy assistants, helping to reduce costs and demands on rehabilitation servicesmay help to improve the functional outcomes of wider rehabilitation interventions by addressing psychological issues which can be a barrier.
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Affiliation(s)
- Natalie Hampson
- Department of Paediatric Clinical Psychology, Sheffield Children's Hospital, Sheffield, UK
| | - Lorraine King
- Department of Clinical Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Hannah Smee
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Barrash J, Stuss DT, Aksan N, Anderson SW, Jones RD, Manzel K, Tranel D. "Frontal lobe syndrome"? Subtypes of acquired personality disturbances in patients with focal brain damage. Cortex 2018; 106:65-80. [PMID: 29883878 PMCID: PMC6120760 DOI: 10.1016/j.cortex.2018.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/29/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Abstract
Conceptualizations of the nature of acquired personality disturbances after brain damage, especially to prefrontal cortex, have progressed from clinical observations of a large, disparate set of disturbances to theories concerning neuroanatomically-based subgroups with prefrontal damage. However, hypothesized subtypes have not yet been studied systematically. Based on our previous investigations of acquired personality disturbances, we hypothesized five subtypes of acquired personality disturbances: Executive Disturbances, Disturbed Social Behavior, Emotional Dysregulation, Hypo-emotionality/De-Energization, and Distress, as well as an undisturbed group. Subtypes were investigated in 194 adults with chronic, stable, focal lesions located in various aspects of prefrontal lobes and elsewhere in the brain, using two different cluster analysis techniques applied to ratings on the Iowa Scales of Personality Change. One technique was a hypothesis-driven approach; the other was a set of strictly empirical analyses to assess the robustness of clusters found in the first analysis. The hypothesis-driven analysis largely supported the hypothesized set of subtypes. However, in contrast to the hypothesis, it suggested that disturbed social behavior and emotional dysregulation are not two distinct subtypes, but two aspects of one multifaceted type of disturbance. Additionally, the so-labeled "executive disturbances" group also showed disturbances in other domains. Results from the second (empirical) set of cluster analyses were consistent with findings from the hypothesis-driven cluster analysis. Overall, findings across the two cluster analyses indicated four subtypes of acquired personality disturbances: (1) executive disturbances in association with generalized disturbance, (2) dysregulation of emotions and behavior, (3) hypo-emotionality and de-energization, and (4) distress/anxiety. These findings show strong correspondence with subtypes suggested by prominent models of prefrontal systems based on neuroanatomically-defined circuits. Clarification of distinctive subtypes of acquired personality disturbances is a step toward enhancing our ability to tailor rehabilitative interventions for patients with prefrontal brain injuries.
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Affiliation(s)
- Joseph Barrash
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Donald T Stuss
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Rotman Research Institute of Baycrest, Toronto, Ontario, Canada
| | - Nazan Aksan
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Steven W Anderson
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Robert D Jones
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kenneth Manzel
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daniel Tranel
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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21
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Semple BD, Zamani A, Rayner G, Shultz SR, Jones NC. Affective, neurocognitive and psychosocial disorders associated with traumatic brain injury and post-traumatic epilepsy. Neurobiol Dis 2018; 123:27-41. [PMID: 30059725 DOI: 10.1016/j.nbd.2018.07.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/08/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022] Open
Abstract
Survivors of traumatic brain injury (TBI) often develop chronic neurological, neurocognitive, psychological, and psychosocial deficits that can have a profound impact on an individual's wellbeing and quality of life. TBI is also a common cause of acquired epilepsy, which is itself associated with significant behavioral morbidity. This review considers the clinical and preclinical evidence that post-traumatic epilepsy (PTE) acts as a 'second-hit' insult to worsen chronic behavioral outcomes for brain-injured patients, across the domains of emotional, cognitive, and psychosocial functioning. Surprisingly, few well-designed studies have specifically examined the relationship between seizures and behavioral outcomes after TBI. The complex mechanisms underlying these comorbidities remain incompletely understood, although many of the biological processes that precipitate seizure occurrence and epileptogenesis may also contribute to the development of chronic behavioral deficits. Further, the relationship between PTE and behavioral dysfunction is increasingly recognized to be a bidirectional one, whereby premorbid conditions are a risk factor for PTE. Clinical studies in this arena are often challenged by the confounding effects of anti-seizure medications, while preclinical studies have rarely examined an adequately extended time course to fully capture the time course of epilepsy development after a TBI. To drive the field forward towards improved treatment strategies, it is imperative that both seizures and neurobehavioral outcomes are assessed in parallel after TBI, both in patient populations and preclinical models.
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Affiliation(s)
- Bridgette D Semple
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, Parkville, VIC, Australia.
| | - Akram Zamani
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia.
| | - Genevieve Rayner
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre (Austin Campus), Heidelberg, VIC, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia; Comprehensive Epilepsy Program, Alfred Health, Australia.
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, Parkville, VIC, Australia.
| | - Nigel C Jones
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, Parkville, VIC, Australia.
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22
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Bartoskova M, Sevcikova M, Durisko Z, Maslej MM, Barbic SP, Preiss M, Andrews PW. The form and function of depressive rumination. EVOL HUM BEHAV 2018. [DOI: 10.1016/j.evolhumbehav.2018.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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23
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MacDonald S. Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury. Brain Inj 2017; 31:1760-1780. [DOI: 10.1080/02699052.2017.1379613] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Sheila MacDonald
- Adjunct Lecturer, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Owner, Sheila MacDonald & Associates, Guelph, Ontario, Canada
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24
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Gomez R, Skilbeck C, Thomas M, Slatyer M. Growth Mixture Modeling of Depression Symptoms Following Traumatic Brain Injury. Front Psychol 2017; 8:1320. [PMID: 28878700 PMCID: PMC5572290 DOI: 10.3389/fpsyg.2017.01320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/18/2017] [Indexed: 11/26/2022] Open
Abstract
Growth Mixture Modeling (GMM) was used to investigate the longitudinal trajectory of groups (classes) of depression symptoms, and how these groups were predicted by the covariates of age, sex, severity, and length of hospitalization following Traumatic Brain Injury (TBI) in a group of 1074 individuals (696 males, and 378 females) from the Royal Hobart Hospital, who sustained a TBI. The study began in late December 2003 and recruitment continued until early 2007. Ages ranged from 14 to 90 years, with a mean of 35.96 years (SD = 16.61). The study also examined the associations between the groups and causes of TBI. Symptoms of depression were assessed using the Hospital Anxiety and Depression Scale within 3 weeks of injury, and at 1, 3, 6, 12, and 24 months post-injury. The results revealed three groups: low, high, and delayed depression. In the low group depression scores remained below the clinical cut-off at all assessment points during the 24-months post-TBI, and in the high group, depression scores were above the clinical cut-off at all assessment points. The delayed group showed an increase in depression symptoms to 12 months after injury, followed by a return to initial assessment level during the following 12 months. Covariates were found to be differentially associated with the three groups. For example, relative to the low group, the high depression group was associated with more severe TBI, being female, and a shorter period of hospitalization. The delayed group also had a shorter period of hospitalization, were younger, and sustained less severe TBI. Our findings show considerable fluctuation of depression over time, and that a non-clinical level of depression at any one point in time does not necessarily mean that the person will continue to have non-clinical levels in the future. As we used GMM, we were able to show new findings and also bring clarity to contradictory past findings on depression and TBI. Consequently, we recommend the use of this approach in future studies in this area.
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Affiliation(s)
- Rapson Gomez
- School of Health Sciences, Federation University, BallaratVIC, Australia
| | - Clive Skilbeck
- Psychology, School of Medicine, University of Tasmania, HobartTAS, Australia
| | - Matt Thomas
- School of Psychology, Charles Sturt University, BathurstNSW, Australia
| | - Mark Slatyer
- Psychology, School of Medicine, University of Tasmania, HobartTAS, Australia
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25
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Yue JK, Burke JF, Upadhyayula PS, Winkler EA, Deng H, Robinson CK, Pirracchio R, Suen CG, Sharma S, Ferguson AR, Ngwenya LB, Stein MB, Manley GT, Tarapore PE. Selective Serotonin Reuptake Inhibitors for Treating Neurocognitive and Neuropsychiatric Disorders Following Traumatic Brain Injury: An Evaluation of Current Evidence. Brain Sci 2017; 7:E93. [PMID: 28757598 PMCID: PMC5575613 DOI: 10.3390/brainsci7080093] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 01/15/2023] Open
Abstract
The prevalence of neuropsychiatric disorders following traumatic brain injury (TBI) is 20%-50%, and disorders of mood and cognition may remain even after recovery of neurologic function is achieved. Selective serotonin reuptake inhibitors (SSRI) block the reuptake of serotonin in presynaptic cells to lead to increased serotonergic activity in the synaptic cleft, constituting first-line treatment for a variety of neurocognitive and neuropsychiatric disorders. This review investigates the utility of SSRIs in treating post-TBI disorders. In total, 37 unique reports were consolidated from the Cochrane Central Register and PubMed (eight randomized-controlled trials (RCTs), nine open-label studies, 11 case reports, nine review articles). SSRIs are associated with improvement of depressive but not cognitive symptoms. Pooled analysis using the Hamilton Depression Rating Scale demonstrate a significant mean decrease of depression severity following sertraline compared to placebo-a result supported by several other RCTs with similar endpoints. Evidence from smaller studies demonstrates mood improvement following SSRI administration with absent or negative effects on cognitive and functional recovery. Notably, studies on SSRI treatment effects for post-traumatic stress disorder after TBI remain absent, and this represents an important direction of future research. Furthermore, placebo-controlled studies with extended follow-up periods and concurrent biomarker, neuroimaging and behavioral data are necessary to delineate the attributable pharmacological effects of SSRIs in the TBI population.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Department of Psychiatry, University of California, San Diego, CA 92093, USA.
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Caitlin K Robinson
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Catherine G Suen
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Department of Neurology, University of Utah School of Medicine, Salt Lake, UT 84112, USA.
| | - Sourabh Sharma
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60660, USA.
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH 45220, USA.
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, CA 92093, USA.
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
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The relationship between neuropsychological performance and depression in patients with traumatic brain injury. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246316654327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traumatic brain injury is a multi-faceted condition that affects individuals on physical, cognitive, and emotional levels. The study investigated the relationship between depression and neuropsychological performance in a group with traumatic brain injury. A retrospective review was conducted on 75 participants who completed neuropsychological assessments. Information on clinical characteristics, sociodemographic information, neuropsychological outcomes, and Beck Depression Inventory scores were included in the analysis. Results indicated that 36% of the participants reported experiencing severe symptoms of depression, 28% moderate symptoms of depression, and 36% mild/minimal symptoms of depression. Performance on the Rey Auditory Verbal Learning Test indicated inverse relationships with depression scores suggesting that traumatic brain injury patients with lower depression scores perform better on verbal memory tasks. Similarly, findings for the written and oral versions of the Symbol Digit Modalities Test reflected inverse correlations with depression scores, indicating that lower depression scores are correlated with increased processing speed and capacity. A significant positive association between the time taken to complete the Trail Making Test Trail A and Trail B and depression scores was found, suggesting that higher depression scores in this sample were related to slower performance speed and lower executive performance. When specific clinical and sociodemographic variables were included as covariates in a partial correlational analysis, neuropsychological performance indicators and depression scores remained significant for Symbol Digit Modalities Test (oral and written), the Rey Auditory Verbal Learning Test Retrieval and Recognition trials, and Trail Making Test (Trail B). This study indicates that in a traumatic brain injury cohort, depression levels are significantly associated with specific neuropsychological performance measures. The findings of this study have implications for psychosocial treatment planning after a traumatic brain injury and contribute to our understandings of the inter-relationship between cognition and emotion.
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Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2016; 33:1969-1994. [PMID: 26729611 DOI: 10.1089/neu.2015.4252] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review examined pre- and post-injury prevalence of, and risk factors for, anxiety disorders and depressive disorders after traumatic brain injury (TBI), based on evidence from structured diagnostic interviews. A systematic literature search was conducted in EMBASE, MEDLINE, Cochrane Central, PubMed, PsycINFO, and Google Scholar. We identified studies in civilian adults with TBI reporting on the prevalence of anxiety and depressive disorders using structured diagnostic interviews and assessed their quality. Pooled pre- and post-injury prevalence estimates of anxiety disorders and depressive disorders were computed. A total of 34 studies described in 68 publications were identified, often assessing anxiety disorders (n = 9), depressive disorders (n = 7), or a combination of disorders (n = 6). Prevalence rates of psychiatric disorders varied widely. Pooled prevalence estimates of anxiety and depressive disorders were 19% and 13% before TBI and 21% and 17% in the first year after TBI. Pooled prevalence estimates increased over time and indicated high long-term prevalence of Axis I disorders (54%), including anxiety disorders (36%) or depressive disorders (43%). Females, those without employment, and those with a psychiatric history before TBI were at higher risk for anxiety and depressive disorders after TBI. We conclude that a substantial number of patients encounter anxiety and depressive disorders after TBI, and that these problems persist over time. All health care settings should pay attention to the occurrence of psychiatric symptoms in the aftermath of TBI to enable early identification and treatment of these disorders and to enhance the recovery and quality of life of TBI survivors.
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Affiliation(s)
- Annemieke C Scholten
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Juanita A Haagsma
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Maryse C Cnossen
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Miranda Olff
- 2 Department of Psychiatry, Center for Psychological Trauma, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Ed F van Beeck
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Suzanne Polinder
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
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Zakzanis KK, Grimes KM. Relationship among apathy, cognition, and real-world disability after mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:559-565. [DOI: 10.1080/23279095.2016.1225216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Kyrsten M. Grimes
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
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Holloway M, Fyson R. Acquired Brain Injury, Social Work and the Challenges of Personalisation. BRITISH JOURNAL OF SOCIAL WORK 2016; 46:1301-1317. [PMID: 27559229 PMCID: PMC4985734 DOI: 10.1093/bjsw/bcv039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increasing numbers of adults in the UK are living with acquired brain injury (ABI), with those affected requiring immediate medical care and longer-term rehabilitative and social care. Despite their social needs, limited attention has been paid to people with ABI within the social work literature and their needs are also often overlooked in policy and guidance. As a means of highlighting the challenge that ABI presents to statutory social work, this paper will start by outlining the common characteristics of ABI and consider the (limited) relevant policy guidance. The particular difficulties of reconciling the needs of people with ABI with the prevailing orthodoxies of personalisation will then be explored, with a particular focus on the mismatch between systems which rest on presumptions autonomy and the circumstances of individuals with ABI-typified by executive dysfunction and lack of insight into their own condition. Composite case studies, drawn from the first author's experiences as a case manager for individuals with ABI, will be used to illustrate the arguments being made. The paper will conclude by considering the knowledge and skills which social workers need in order to better support people with ABI.
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Affiliation(s)
- Mark Holloway
- Head First, Grove Mills, Hawkhurst, Kent, TN18 4AS, UK
| | - Rachel Fyson
- School of Sociology and Social Policy, University of Nottingham, Nottingham, NG7 2RD, UK
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Zaninotto AL, Vicentini JE, Fregni F, Rodrigues PA, Botelho C, de Lucia MCS, Paiva WS. Updates and Current Perspectives of Psychiatric Assessments after Traumatic Brain Injury: A Systematic Review. Front Psychiatry 2016; 7:95. [PMID: 27378949 PMCID: PMC4906018 DOI: 10.3389/fpsyt.2016.00095] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/19/2016] [Indexed: 01/06/2023] Open
Abstract
Neuropsychological and psychiatric disorders represent a major concern and cause of disabilities after the trauma, contributing to worse recovery after traumatic brain injury (TBI). However, the lack of well-defined parameters to evaluate patient's psychiatric disorders leads to a wide range of diagnoses and symptoms. The aim of this study was to perform a review of literature in order to gather data of the most common scales and inventories used to assess and diagnose depression, anxiety, and posttraumatic stress disorder (PTSD) after TBI. We conducted a literature search via MEDLINE, PubMed, and Web of Science. We included reviews, systematic reviews, and meta-analysis studies, and we used the following keywords: "traumatic brain injury OR TBI," "depression OR depressive disorder," "anxiety," and "posttraumatic stress disorder OR PTSD." From 610 titles, a total of 68 systematic reviews or meta-analysis were included in the section "Results" of this review: depression (n = 32), anxiety (n = 9), and PTSD (n = 27). Depression after TBI is a more established condition, with more homogeneous studies. Anxiety and PTSD disorders have been studied in a heterogeneous way, usually as comorbidity with other psychiatric disorders. Some scales and inventories designed for the general community may not be appropriate for patients with TBI.
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Affiliation(s)
- Ana Luiza Zaninotto
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | - Jessica Elias Vicentini
- Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
| | | | - Cibele Botelho
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | | | - Wellingson Silva Paiva
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
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Spikman JM, Timmerman ME, Coers A, van der Naalt J. Early Computed Tomography Frontal Abnormalities Predict Long-Term Neurobehavioral Problems But Not Affective Problems after Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2016; 33:22-8. [DOI: 10.1089/neu.2014.3788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jacoba M. Spikman
- Department of Clinical and Developmental Neuropsychology, University of Groningen, the Netherlands
- Department of Neurology, University of Groningen, the Netherlands
| | - Marieke E. Timmerman
- Department of Psychometrics and Statistics, University of Groningen, the Netherlands
| | - Annemiek Coers
- Department of Neurology, University of Groningen, the Netherlands
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32
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Traumatic Brain Injury in the Military: Biomechanics and Finite Element Modelling. STUDIES IN MECHANOBIOLOGY, TISSUE ENGINEERING AND BIOMATERIALS 2016. [DOI: 10.1007/8415_2016_189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Stahl B, Van Lancker Sidtis D. Tapping into neural resources of communication: formulaic language in aphasia therapy. Front Psychol 2015; 6:1526. [PMID: 26539131 PMCID: PMC4611089 DOI: 10.3389/fpsyg.2015.01526] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Benjamin Stahl
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin Berlin, Germany
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34
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Dou J, Tang J, Lu CH, Jiang ES, Wang PX. A study of suicidal ideation in acute ischemic stroke patients. Health Qual Life Outcomes 2015; 13:7. [PMID: 25613218 PMCID: PMC4308882 DOI: 10.1186/s12955-014-0198-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/18/2014] [Indexed: 12/19/2022] Open
Abstract
Background Increasing evidences indicate that stroke confers a substantial risk for suicidal ideation. The aim of this study was to identify risk factors of suicidal ideation in acute ischemic stroke patients. Method A total of 271 consecutive patients with acute ischemic stroke were recruited in Huai-He hospital or the First People’s Hospital, Kaifeng City, China. Demographic and clinical variables were collected and evaluated. Suicidal ideation was assessed using the Beck Scale for Suicide Ideation (BSI). Multivariate logistic regression was applied to determine the risk factors of suicidal ideation. Results Suicidal ideation was identified in 29 patients (10.7%). It was more frequent in patients who lived in rural region, with pre-/post-stroke depression or diabetes, had a higher NIHSS score, had no confidence in disease treatment, or had a poor coping style. Living in rural region (OR 2.59, 95% CI 1.02-6.58), the presence of pre-stroke depression (OR 11.74, 95% CI 4.45-31.01), stroke severity (OR 1.20, 95% CI 1.08-1.33), having no confidence in disease treatment (OR 14.70, 95% CI 2.60-83.15), and post-stroke depression (OR 16.22, 95% CI 6.40-41.10) were independent risk factors of suicidal ideation. Conclusion Several factors may be associated with an increased risk of suicidal ideation in acute ischemic stroke patients, including pre-/post-stroke depression, more severe stroke, having no confidence in treatment, as well as living in rural region. Our findings may have implication in risk assessment and intervention for acute ischemic stroke patients in reducing the burdens of suicidal ideation.
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Affiliation(s)
- Jin Dou
- Institute of Public Health, School of Nursing, Henan University, Jinming Campus, Kaifeng, HN, China, 475004.
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Chu-Hong Lu
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - En-She Jiang
- Institute of Public Health, School of Nursing, Henan University, Jinming Campus, Kaifeng, HN, China, 475004.
| | - Pei-Xi Wang
- Institute of Public Health, School of Nursing, Henan University, Jinming Campus, Kaifeng, HN, China, 475004. .,Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
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Holloway M. How is ABI assessed and responded to in non-specialist settings? Is specialist education required for all social care professionals? ACTA ACUST UNITED AC 2014. [DOI: 10.1108/scn-12-2013-0043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to examine the research into prevalence of acquired brain injury in non-ABI specialist services, the impact of the invisible aspects of executive impairment and loss of insight upon functioning and to question how this is assessed and managed by generalist services.
Design/methodology/approach
– A literature search was undertaken to identify where people with an ABI may come in to contact with services that are not specifically designed to meet their needs.
Findings
– ABI is prevalent amongst users of a variety of community, inpatient and criminal justice services. The common albeit invisible consequences of ABI complicate assessment, service use and or treatment particularly in the context of a lack of under pinning knowledge and experience amongst the staff in non-specialist ABI services. As a consequence risks to children and adults are increased, opportunities for rehabilitation and growth are lost and human potential squandered. Addressing the first stage in this process, developing knowledge of the consequences of ABI and how to assess need, is a pre-requisite for change.
Practical implications
– An absence of basic underlying knowledge of the consequences of ABI impacts upon assessment and so limits the effectiveness of services. A consequence of this is manifest in the over-representation of people with an ABI to be found in non-specialist settings.
Originality/value
–Little research is undertaken from a social and community perspective into the impact of ABI over the longer term for those who have no contact with specialist services and yet, quite clearly by their use of other services, have unidentified, unrecognised and un-responded to needs.
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Heled E, Sverdlik A, Agranov E. Persistent extreme regressive behavior in severe traumatic brain injury patients: a rare neurological phenomenon. Neurocase 2014; 20:487-95. [PMID: 23972070 DOI: 10.1080/13554794.2013.826680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Regressive behavior is a known sequela after severe traumatic brain injury (TBI). However, prolonged "infantile-like" behavior has received little attention in the literature, suggesting that this is a rare phenomenon. It is typically characterized by long-lasting childish, extremely dependent, and sometimes aggressive behavior, which is distinguished from the expected recovery process. The relevant theoretical framework lies in the field of disorders called "Neuropathologies of the self" (NPS). We report three cases of young adults who, following a severe TBI, developed continual regressive behavior. The Disability Rating Scale (DRS) was used to assess possible change in their condition. First, while admitted, which was performed in retrospect, and again 6 years later at the time stated. Inter-rater reliability for the scale items showed adequate correlation. Results showed no significant difference in patients' scores, indicating persistent functional difficulties. We conclude that this "regressive syndrome" presents an unusual form of behavior that is stable over time. It seems to be in line with other NPS disorders, and may stem from an interaction of organic factors and primary mental complexity. Nevertheless, further research is required to examine the factors affecting the emergence and recovery from this phenomenon.
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Affiliation(s)
- Eyal Heled
- a The Day Treatment Rehabilitation Unit, Chaim Sheba Medical Center , Ramat Gan , Israel
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37
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Kuenemund A, Zwick S, Doering BK, Conrad N, Rief W, Exner C. Decline in attainability of communion and agency life goals over 2 years following acquired brain injury and the impact on subjective well-being. Neuropsychol Rehabil 2013; 23:678-97. [DOI: 10.1080/09602011.2013.801779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hofer H, Frigerio S, Frischknecht E, Gassmann D, Gutbrod K, Müri RM. Diagnosis and treatment of an obsessive-compulsive disorder following traumatic brain injury: a single case and review of the literature. Neurocase 2013; 19:390-400. [PMID: 22784309 DOI: 10.1080/13554794.2012.690423] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A 27-year-old patient with traumatic brain injury and neuropsychiatric symptoms fitting the obsessive-compulsive disorder was investigated. Brain CT-scan revealed left temporal and bilateral fronto-basal parenchymal contusions. Main Outcome Measure was the Yale-Brown Obsessive Compulsive Scale at pre- and post-treatment and at 6 months follow-up. The combination of pharmacotherapy and psychotherapy resulted in lower intensity and frequency of symptoms. Our case illustrates the importance of a detailed diagnostic procedure in order to provide appropriate therapeutic interventions. Further studies are needed to guide the clinician in determining which patients are likely to benefit from a psychotherapeutic intervention in combination with pharmacotherapy.
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Affiliation(s)
- Helene Hofer
- Department of Neurology, University Hospital, Bern, Switzerland.
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39
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Humphreys I, Wood RL, Phillips CJ, Macey S. The costs of traumatic brain injury: a literature review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:281-7. [PMID: 23836998 PMCID: PMC3699059 DOI: 10.2147/ceor.s44625] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to review the literature relating to the psychosocial costs associated with traumatic brain injury (TBI). METHODS Nine online journal databases, including MEDLINE, CINAHL, PsychINFO, and PUBMED, were queried for studies between July 2010 and May 2012 pertaining to the economic burden of head injuries. Additional studies were identified through searching bibliographies of related publications and using Google internet search engine. RESULTS One hundred and eight potentially relevant abstracts were identified from the journal databases. Ten papers were chosen for discussion in this review. All but two of the chosen papers were US studies. The studies included a cost-benefit analysis of the implementation of treatment guidelines from the US brain trauma foundation and a cost-effectiveness analysis of post-acute traumatic brain injury rehabilitation. CONCLUSION Very little research has been published on the economic burden that mild and moderate traumatic brain injury patients pose to their families, careers, and society as a whole. Further research is needed to estimate the economic burden of these patients on healthcare providers and social services and how this can impact current health policies and practices.
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Affiliation(s)
- Ioan Humphreys
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Wales, UK
| | - Rodger L Wood
- Department of Psychology, College of Human and Health Sciences, Swansea University, Wales, UK
| | - Ceri J Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Wales, UK
| | - Steven Macey
- School of Medicine, Swansea University, Wales, UK
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Pompili M, Venturini P, Campi S, Seretti ME, Montebovi F, Lamis DA, Serafini G, Amore M, Girardi P. Do stroke patients have an increased risk of developing suicidal ideation or dying by suicide? An overview of the current literature. CNS Neurosci Ther 2013; 18:711-21. [PMID: 22943140 DOI: 10.1111/j.1755-5949.2012.00364.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Stroke is a leading cause of death that affects 15 million people worldwide each year. Increasing evidence suggests that stroke confers substantial risk for suicide and following a stroke, patients frequently develop poststroke depression, which is a well-established risk factor for suicide. In this overview of the current literature, we examined the association between suffering a stroke and subsequent risk for suicide and suicidal ideation. We performed a careful MedLine, Excerpta Medica, PsycLit, PsycInfo, and Index Medicus search to identify all articles and book chapters in English. We initially selected 31 articles published between 1990 and 2011; however, only 16 studies were included in this review. All articles identified stroke as a significant risk factor for suicide, especially among depressed patients, providing further support for poststroke depression and suicidality. The results also indicated that there were differences between patients who developed acute-onset suicidal plans and those who reported delayed-onset plans, which occurred more frequently. Many of the stroke patients who died by suicide suffered from depression prior to their death, suggesting that being diagnosed with a mood disorder contributes to an increased risk of suicide in this population. Suffering from a stroke increases the risk of dying by suicide and developing suicidal ideation, particularly in young adults and women. The factors found to confer the most risk for suicidality were depression, previous mood disorder, prior history of stroke, and cognitive impairment.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
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Abstract
This chapter begins with a discussion about the common characteristics of people with memory deficits resulting from brain injury followed by a description of a typical patient referred for memory rehabilitation. We then address some general principles to help people with memory deficits. These principles include ways of improving encoding, storage, and retrieval. The next section addresses more specific strategies to help people (a) cope without a memory through environmental modifications, (b) learn more efficiently (particularly through errorless learning strategies), and (c) compensate for their problems through external memory aids. A memory aids resource center is described. The impact of memory impairment on emotions is considered. A summary of the main components of a memory rehabilitation program is provided. The overall conclusion is that rehabilitation can help people to compensate for, bypass, or reduce their everyday problems and thus survive more efficiently in their own most appropriate environments.
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Affiliation(s)
- Barbara A Wilson
- The Oliver Zangwill Centre, Princess of Wales Hospital, Cambs, UK.
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42
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Waldron B, Casserly LM, O'Sullivan C. Cognitive behavioural therapy for depression and anxiety in adults with acquired brain injury. What works for whom? Neuropsychol Rehabil 2013; 23:64-101. [DOI: 10.1080/09602011.2012.724196] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Neurobehavioral disorders are composed of a large group of behavioral impairments seen in association with brain disease (e.g., stroke, multiple sclerosis, dementia, and neuro-oncological conditions), transient as well as permanent brain impairments (e.g., metabolic and toxic encephalopathies), and/or injury (e.g., trauma, hypoxia, and/or ischemia). The neurorehabilitative assessment and management of such disorders is often poorly addressed in the context of overall neurological, psychiatric, and rehabilitative care. Too often, more basic, yet critical, aspects of behavioral assessment and treatment are not addressed or only superficially addressed by evaluating clinicians. Physicians often overly rely on pharmacological interventions as initial and/or sole treatment approaches rather than taking a pragmatic biopsychosocial approach that focuses on holistic disease state management. This chapter provides readers with an overview of the common behavioral impairments associated with brain dysfunction due to disease, injury, or toxicity. Details regarding the nature of impairments such as localization-related syndromes, affective disorders and personality disorders, among others are expounded. Principles of neurobehavioral assessment and treatment are examined including general guidelines for eliciting a history and physical, behavioral analysis, and functional behavioral assessment. General treatment caveats are provided including discussion of impairment and disability adaptation, and creation of positive behavioral supports. The topic of pharmacological management of neurobehavioral disorders is covered in numerous other references including Chapter 33 of this text.
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Abstract
External physical insult, an accidental blow, acceleration followed by rapid deceleration, or explosive blasts can cause traumatic brain injury (TBI). During the last few years, experts have realized that even mild blows to the head can cause lasting damage. Better understanding of how TBI occurs has improved the probability of survival for those with the most serious injuries. Graded using the Glasgow Coma Scale, TBI may leave its sufferers awake, in periods of alertness interspersed with cognitive confusion, or deep in coma. Falls recently displaced motor vehicle accidents as the leading cause of TBI. Elders are at high risk for falls and TBI, and they may be unaware of possible lasting complications. Pharmacologic therapies for patients who have suffered TBI are, by necessity, individualized.
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Affiliation(s)
- Jeannette Y Wick
- University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
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45
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Wyman-Chick KA. Combining Cognitive-Behavioral Therapy and Interpersonal Therapy for Geriatric Depression With Complicated Grief. Clin Case Stud 2012. [DOI: 10.1177/1534650112436679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The focus of this article is to discuss the application of cognitive-behavioral therapy and interpersonal therapy with a 65-year-old woman experiencing depressive symptoms and complicated grief associated with a brain injury and an acquired disability. Findings indicate the intervention, which consisted of 20 sessions, produced significant clinical improvement in depressive symptoms as measured by the Geriatric Depression Scale as calculated by the Reliable Change Index. Cognitive-behavioral techniques, such as cognitive restructuring and behavioral activation, were modified according to the client’s cognitive functioning and physical abilities. Interpersonal therapy techniques were used to examine current relationships and grief related to the acquired brain injury.
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46
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Schönberger M, Ponsford J, Reutens D, Beare R, Clarke D, O'Sullivan R. The relationship between mood disorders and MRI findings following traumatic brain injury. Brain Inj 2011; 25:543-50. [PMID: 21534732 DOI: 10.3109/02699052.2011.565013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND High rates of depression have been reported in individuals with traumatic brain injury (TBI). The purpose of the current study was to investigate the relationship between structural MRI findings and the development of novel cases of post-injury depression in this population METHODS The study has a cross-sectional design. Assessments were conducted on average 2.2 years post-injury. Participants were 54 individuals (76% male, mean age 35 years, median PTA duration 16 days) who had sustained a TBI. Depression was assessed with the Structured Clinical Interview for DSM-IV (SCID-IV). Structural MRI scans were performed with a 1.5 Tesla machine. RESULTS The presence of lesions in the frontal, temporal, parietal and the sublobar regions was not related to depression. However, an imbalance of left vs right frontal and parietal viable brain volumes was related to the development of depression. DISCUSSION These findings are in support of Heller's model of emotion processing, but should be replicated using larger samples. Potential clinical implications are discussed in the manuscript.
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Affiliation(s)
- Michael Schönberger
- Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Germany.
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47
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Wall SE, Huw Williams W, Morris RG, Bramham J. The development of a new measure of social-emotional functioning for young adolescents. Clin Child Psychol Psychiatry 2011; 16:301-15. [PMID: 21791523 DOI: 10.1177/1359104511401187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Social and emotional impairments are frequently reported following acquired brain injury, including an inability to adopt another's perspective, empathize, and display guilt, and inappropriate social conduct. Case studies suggest that these problems are particularly apparent when the injury is sustained in childhood, with deficits increasing with age and persisting throughout adulthood. In addition to these deficits, individuals may have limited insight into their cognitive or social-emotional deficits, which in turn may also affect social functioning and have implications for the success of rehabilitation. Despite the frequency of these problems, there is a dearth of suitable measures for detecting them in children or adolescents. The purpose of the current study was to develop one such measure from a measure initially intended for adults. Normative data were collected from 109 typically-developing 11- to 14-year-olds and their parent/guardian on the Social-Emotional Questionnaire for Children (SEQ-C). Factor and reliability analyses were conducted and the subscales were then explored in association with key demographic information. Social-emotional development showed a fluctuating course across early adolescence, alongside some gender differences. This measure, with its normative data, will be of value to neuropsychologists wishing to explore such functioning in their clinical practice.
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48
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Carroll E, Coetzer R. Identity, grief and self-awareness after traumatic brain injury. Neuropsychol Rehabil 2011; 21:289-305. [DOI: 10.1080/09602011.2011.555972] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jones JM, Haslam SA, Jetten J, Williams WH, Morris R, Saroyan S. That which doesn’t kill us can make us stronger (and more satisfied with life): The contribution of personal and social changes to well-being after acquired brain injury. Psychol Health 2011; 26:353-69. [DOI: 10.1080/08870440903440699] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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