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Haghish EF, Sahuquillo J, Radoi A, Pomposo I, Lozano GC. Validating the Spanish translation of the posttraumatic stress disorder checklist (PCL-5) in a sample of individuals with traumatic brain injury. Front Psychol 2024; 15:1216435. [PMID: 38911962 PMCID: PMC11192184 DOI: 10.3389/fpsyg.2024.1216435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 04/15/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction There is controversy regarding the comorbidity of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The present study translated the PTSD Checklist for DSM-5 (PCL-5) to Spanish and validated it in a sample of patients with TBI 6 months after the injury. Methods The study included 233 patients (162 males and 71 females) recruited from four Spanish hospitals within 24 h of traumatic brain injury. A total of 12.2% of the sample met the provisional PTSD diagnostic criteria, and the prevalence was equal between male and female participants. Results The analysis confirmed the internal consistency of the translated instrument (α = 0.95). The concurrent validity of the instrument was confirmed based on high correlation coefficients of 0.7 and 0.74 with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9), respectively. Exploratory factor analysis also confirmed that the items on the PCL-5 can be differentiated from the GAD-7 and PHQ-9 items. Confirmatory factor analysis (CFA) was used to examine the structural validity of the Spanish translation of the PCL-5 with three different models. CFA partially confirmed the four-factor PTSD model, whereas both the six-factor anhedonia model and the seven-factor hybrid model showed adequate fit. However, the difference between the anhedonia and hybrid models was not statistically significant; moreover, both models showed signs of overfitting. Therefore, the utility of these models should be reexamined in future studies. Conclusion Overall, the results suggest that the Spanish translation of the PCL-5 is a reliable and valid instrument for screening PTSD symptoms among Spanish TBI patients. The Spanish translation of the PCL-5 is also presented in the manuscript.
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Affiliation(s)
- E. F. Haghish
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Juan Sahuquillo
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Barcelona, Balearic Islands, Spain
| | - Andreea Radoi
- BarcelonaBeta Brain Research Center, Barcelona, Catalonia, Spain
| | - Ingio Pomposo
- Department of Neurosurgery, Cruces University Hospital, Bilbao, Spain
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2
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Robayo LE, Govind V, Salan T, Cherup NP, Sheriff S, Maudsley AA, Widerström-Noga E. Neurometabolite alterations in traumatic brain injury and associations with chronic pain. Front Neurosci 2023; 17:1125128. [PMID: 36908781 PMCID: PMC9997848 DOI: 10.3389/fnins.2023.1125128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Traumatic brain injury (TBI) can lead to a variety of comorbidities, including chronic pain. Although brain tissue metabolite alterations have been extensively examined in several chronic pain populations, it has received less attention in people with TBI. Thus, the primary aim of this study was to compare brain tissue metabolite levels in people with TBI and chronic pain (n = 16), TBI without chronic pain (n = 17), and pain-free healthy controls (n = 31). The metabolite data were obtained from participants using whole-brain proton magnetic resonance spectroscopic imaging (1H-MRSI) at 3 Tesla. The metabolite data included N-acetylaspartate, myo-inositol, total choline, glutamate plus glutamine, and total creatine. Associations between N-acetylaspartate levels and pain severity, neuropathic pain symptom severity, and psychological variables, including anxiety, depression, post-traumatic stress disorder (PTSD), and post-concussive symptoms, were also explored. Our results demonstrate N-acetylaspartate, myo-inositol, total choline, and total creatine alterations in pain-related brain regions such as the frontal region, cingulum, postcentral gyrus, and thalamus in individuals with TBI with and without chronic pain. Additionally, NAA levels in the left and right frontal lobe regions were positively correlated with post-concussive symptoms; and NAA levels within the left frontal region were also positively correlated with neuropathic pain symptom severity, depression, and PTSD symptoms in the TBI with chronic pain group. These results suggest that neuronal integrity or density in the prefrontal cortex, a critical region for nociception and pain modulation, is associated with the severity of neuropathic pain symptoms and psychological comorbidities following TBI. Our data suggest that a combination of neuronal loss or dysfunction and maladaptive neuroplasticity may contribute to the development of persistent pain following TBI, although no causal relationship can be determined based on these data.
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Affiliation(s)
- Linda E Robayo
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Teddy Salan
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Nicholas P Cherup
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Andrew A Maudsley
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States.,Department of Neurological Surgery, University of Miami, Miami, FL, United States
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3
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Sarwer DB, Siminoff LA, Gardiner HM, Spitzer JC. The psychosocial burden of visible disfigurement following traumatic injury. Front Psychol 2022; 13:979574. [PMID: 36110275 PMCID: PMC9468754 DOI: 10.3389/fpsyg.2022.979574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 12/15/2022] Open
Abstract
Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.
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Affiliation(s)
- David B. Sarwer
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
- *Correspondence: David B. Sarwer,
| | - Laura A. Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Heather M. Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
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4
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Robayo LE, Govind V, Vastano R, Felix ER, Fleming L, Cherup NP, Widerström-Noga E. Multidimensional pain phenotypes after Traumatic Brain Injury. FRONTIERS IN PAIN RESEARCH 2022; 3:947562. [PMID: 36061413 PMCID: PMC9437424 DOI: 10.3389/fpain.2022.947562] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
More than 50% of individuals develop chronic pain following traumatic brain injury (TBI). Research suggests that a significant portion of post-TBI chronic pain conditions is neuropathic in nature, yet the relationship between neuropathic pain, psychological distress, and somatosensory function following TBI is not fully understood. This study evaluated neuropathic pain symptoms, psychological and somatosensory function, and psychosocial factors in individuals with TBI (TBI, N = 38). A two-step cluster analysis was used to identify phenotypes based on the Neuropathic Pain Symptom Inventory and Beck's Anxiety Inventory scores. Phenotypes were then compared on pain characteristics, psychological and somatosensory function, and psychosocial factors. Our analyses resulted in two different neuropathic pain phenotypes: (1) Moderate neuropathic pain severity and anxiety scores (MNP-AS, N = 11); and (2) mild or no neuropathic pain symptoms and anxiety scores (LNP-AS, N = 27). Furthermore, the MNP-AS group exhibited greater depression, PTSD, pain severity, and affective distress scores than the LNP-AS group. In addition, thermal somatosensory function (difference between thermal pain and perception thresholds) was significantly lower in the MNP-AS compared to the LNP-AS group. Our findings suggest that neuropathic pain symptoms are relatively common after TBI and are not only associated with greater psychosocial distress but also with abnormal function of central pain processing pathways.
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Affiliation(s)
- Linda E. Robayo
- Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL, United States
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Roberta Vastano
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Elizabeth R. Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Loriann Fleming
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nicholas P. Cherup
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Eva Widerström-Noga
- Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL, United States
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Eva Widerström-Noga
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5
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Traumatic Stress and Depression Risk Screening at an ACS Verified Trauma Center. J Trauma Nurs 2022; 29:142-151. [PMID: 35536343 DOI: 10.1097/jtn.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physiological trauma that requires admission to an emergency department may result in psychological distress. As many as 20%-40% of civilians who experience trauma develop traumatic stress disorders and depression postinjury. Yet, less than 10% of trauma centers implement screening for traumatic stress and depression risk. OBJECTIVE This project aimed to develop, implement, and evaluate a traumatic stress and depression risk screening policy. METHODS Twelve trauma advanced practice providers implemented the newly developed traumatic stress and depression risk screening policy at an American College of Surgeons verified Level II trauma center. Trauma patients admitted for greater than 24 hr, 14 years of age or older, with a Glasgow Coma Scale score greater than 13 were eligible for screening using the Injured Trauma Survivor Screen. RESULTS During the 6-week data collection period, 114 trauma patients presented to the emergency department. Of those, 82 (72%) met inclusion criteria, 77 (94%) eligible trauma patients were screened, and seven (9%) patients screened positive. Patients not eligible for screening were discharged within 24 hr or were too confused to answer questions. An evaluation survey revealed that the advanced practice providers thought that the screening policy was easy to use, feasible, not very time-consuming, and should be continued in the future. CONCLUSION This project demonstrated the ease and effectiveness of implementing a traumatic stress and depression risk screening policy and that only minor changes are needed to make it sustainable.
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6
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Neural stem cell therapy in conjunction with curcumin loaded in niosomal nanoparticles enhanced recovery from traumatic brain injury. Sci Rep 2022; 12:3572. [PMID: 35246564 PMCID: PMC8897489 DOI: 10.1038/s41598-022-07367-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/16/2022] [Indexed: 12/28/2022] Open
Abstract
Despite a great amount of effort, there is still a need for reliable treatments of traumatic brain injury (TBI). Recently, stem cell therapy has emerged as a new avenue to address neuronal regeneration after TBI. However, the environment of TBI lesions exerts negative effects on the stem cells efficacy. Therefore, to maximize the beneficial effects of stem cells in the course of TBI, we evaluated the effect of human neural stem/progenitor cells (hNS/PCs) and curcumin-loaded niosome nanoparticles (CM-NPs) on behavioral changes, brain edema, gliosis, and inflammatory responses in a rat model of TBI. After TBI, hNS/PCs were transplanted within the injury site and CM-NPs were orally administered for 10 days. Finally, the effect of combination therapy was compared to several control groups. Our results indicated a significant improvement of general locomotor activity in the hNS/PCs + CM-NPs treatment group compared to the control groups. We also observed a significant improvement in brain edema in the hNS/PCs + CM-NPs treatment group compared to the other groups. Furthermore, a significant decrease in astrogliosis was seen in the combined treatment group. Moreover, TLR4-, NF-κB-, and TNF-α- positive cells were significantly decreased in hNS/PCs + CM-NPs group compared to the control groups. Taken together, this study indicated that combination therapy of stem cells with CM-NPs can be an effective therapy for TBI.
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7
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Chan V, Toccalino D, Omar S, Shah R, Colantonio A. A systematic review on integrated care for traumatic brain injury, mental health, and substance use. PLoS One 2022; 17:e0264116. [PMID: 35239715 PMCID: PMC8893633 DOI: 10.1371/journal.pone.0264116] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/03/2022] [Indexed: 12/22/2022] Open
Abstract
Traumatic brain injuries (TBI) and mental health or substance use disorders (MHSU) are global public health concerns due to their prevalence and impact on individuals and societies. However, care for individuals with TBI and MHSU remains fragmented with a lack of appropriate services and supports across the continuum of healthcare. This systematic review provided an evidence-based foundation to inform opportunities to mobilize and adapt existing resources to integrate care for individuals with TBI and MHSU by comprehensively summarizing existing integrated activities and reported barriers and facilitators to care integration. MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Sociological Abstracts, and Dissertations & Theses Global were independently reviewed by two reviewers based on pre-determined eligibility criteria. Data on the integration activity, level and type of integration, reported barriers and facilitators, and the strategies aligning with the World Health Organization’s (WHO) Framework on Integrated Person-Centred Care were extracted to form the basis for a narrative synthesis. Fifty-nine peer-reviewed articles were included, describing treatments (N = 49), programs (N = 4), or screening activities (N = 7). Studies discussing clinical integration at the micro- (N = 38) and meso- (N = 10) levels, service integration at the micro- (N = 6) and meso- (N = 5) levels, and functional integration at the meso-level (N = 1) were identified. A minority of articles reported on facilitators (e.g., cognitive accommodations in treatment plans; N = 7), barriers (e.g., lack of education on cognitive challenges associated with TBI; N = 2), or both (N = 6), related to integrating care. This review demonstrated that integrated TBI and MHSU care already exists across a range of levels and types. Given the finite and competing demands for healthcare resources, cognitive accommodations across treatment plans to facilitate integrated TBI and MHSU care should be considered. Multidisciplinary teams should also be explored to provide opportunities for education among health professionals so they can be familiar with TBI and MHSU. Trial registration: Prospero Registration: CRD42018108343.
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Affiliation(s)
- Vincy Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Samira Omar
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Riya Shah
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Department of Psychology, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Angela Colantonio
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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8
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Lange RT, French LM, Bailie JM, Merritt VC, Pattinson CL, Hungerford LD, Lippa SM, Brickell TA. Clinical utility of PTSD, resilience, sleep, and blast as risk factors to predict poor neurobehavioral functioning following traumatic brain injury: A longitudinal study in U.S. military service members. Qual Life Res 2022; 31:2411-2422. [PMID: 35076825 DOI: 10.1007/s11136-022-03092-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI). METHODS Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up. RESULTS Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to predict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue, Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3-72.4). However, poor sleep and low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1-29.8). CONCLUSION PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used clinically for targeted early interventions.
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Affiliation(s)
- Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA. .,Walter Reed National Military Medical Center, Bethesda, MD, USA. .,National Intrepid Center of Excellence, Bethesda, MD, USA. .,University of British Columbia, Vancouver, BC, Canada. .,General Dynamics Information Technology, Falls Church, VA, USA.
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Naval Hospital Camp Pendleton, Oceanside, CA, USA.,General Dynamics Information Technology, Falls Church, VA, USA
| | - Victoria C Merritt
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
| | | | - Lars D Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Naval Medical Center San Diego, San Diego, CA, USA.,General Dynamics Information Technology, Falls Church, VA, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,General Dynamics Information Technology, Falls Church, VA, USA
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9
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Jackson JE, Do-Nguyen A, Ewbank C, Anderson C, Newton C, Schreiber M. Feasibility of PTSD risk identification in pediatric trauma patients using PsySTART: A pilot study. J Pediatr Surg 2021; 56:2348-2353. [PMID: 33836845 DOI: 10.1016/j.jpedsurg.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trauma patients undergo a standardized history and physical, however identification of mental health risk factors is not typically included. We aimed to assess the feasibility of using a modified version of Psychological Simple Triage and Rapid Treatment (PsySTART) to identify post-traumatic stress disorder (PTSD) risk factors in pediatric trauma patients. We hypothesized that PsySTART could identify risk factors and be integrated into the electronic medical record (EMR). METHODS Trauma patients 10-17 years old at a level II pediatric trauma center from 2014 to 2015 were screened. PsySTART was used on a pilot cohort to determine if risk factors were present. PsySTART was then integrated into an automated EMR workflow and completion rates were evaluated. RESULTS PsySTART was completed in a pilot cohort of 63 patients with the following findings: 33.3% (n = 21) with 1 risk factor, 22.2% (n = 14) with 2 risk factors, and 19.1% (n = 12) with ≥3 risk factors. The most commonly identified risk factor was, "felt or expressed extreme fear or panic" (n = 27, 43.0%). After EMR integration, PsySTART was successfully completed with automatic consults in 156 of 198 patients (78.8%). CONCLUSIONS PsySTART identified risk factors in pediatric trauma patients. EMR integration was feasible and led to proactive psychological management and intervention. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jordan E Jackson
- Department of Surgery, University of California, San Francisco East Bay, Oakland, CA USA.
| | - Amy Do-Nguyen
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Clifton Ewbank
- Department of Surgery, University of California, San Francisco East Bay, Oakland, CA USA
| | - Craig Anderson
- Department of Emergency Medicine, University of California Irvine, Irvine, CA USA
| | - Christopher Newton
- Department of Surgery, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA USA
| | - Merritt Schreiber
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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10
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Lippa SM, French LM, Brickell TA, Driscoll AE, Glazer ME, Tippett CE, Sullivan JK, Lange RT. Post-Traumatic Stress Disorder Symptoms Are Related to Cognition after Complicated Mild and Moderate Traumatic Brain Injury but Not Severe and Penetrating Traumatic Brain Injury. J Neurotrauma 2021; 38:3137-3145. [PMID: 34409857 DOI: 10.1089/neu.2021.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although post-traumatic stress disorder (PTSD) has been associated with worse cognitive outcomes after mild traumatic brain injury (TBI), its impact has not been evaluated after more severe TBI. This study aimed to determine whether PTSD symptoms are related to cognition after complicated mild, moderate, severe, and penetrating TBI. Service members (n = 137) with a history of complicated mild/moderate TBI (n = 64) or severe/penetrating TBI (n = 73) were prospectively enrolled from United States Military Treatment Facilities. Participants completed a neuropsychological assessment one year or more post-injury. Six neuropsychological composite scores and an overall test battery mean (OTBM) were considered. Participants were excluded if there was evidence of invalid responding. Hierarchical linear regressions were conducted evaluating neuropsychological performance. The interaction between TBI severity and PTSD Checklist-Civilian version total score was significant for processing speed (β = 0.208, p = 0.034) and delayed memory (β = 0.239, p = 0.021) and trended toward significance for immediate memory (β = 0.190, p = 0.057) and the OTBM (β = 0.181, p = 0.063). For each of these composite scores, the relationship between PTSD symptoms and cognition was stronger in the complicated mild/moderate TBI group than the severe/penetrating TBI group. Within the severe/penetrating TBI group, PTSD symptoms were unrelated to cognitive performance. In contrast, within the complicated mild/moderate TBI group, PTSD symptoms were significantly related to processing speed (R2Δ = 0.077, β = -0.280, p = 0.019), immediate memory (R2Δ = 0.197, β = -0.448, p < 0.001), delayed memory (R2Δ = 0.176, β = -0.423, p < 0.001), executive functioning (R2Δ = 0.100, β = -0.317, p = 0.008), and the OTBM (R2Δ = 0.162, β = -0.405, p < 0.001). The potential impact of PTSD symptoms on cognition, over and above the impact of brain injury alone, should be considered with service members and veterans with a history of complicated mild/moderate TBI. In addition, in research comparing cognitive outcomes between patients with histories of complicated-mild, moderate, severe, and/or penetrating TBI, it will be important to account for PTSD symptoms.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracey A Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA.,Centre of Excellence on Post-traumatic Stress Disorder, Ottawa, ON, Canada
| | - Angela E Driscoll
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Megan E Glazer
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Corie E Tippett
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Jamie K Sullivan
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, General Dynamics Information Technology, Falls Church, Virginia, USA.,University of British Columbia, Vancouver, British Columbia, Canada.,Centre of Excellence on Post-traumatic Stress Disorder, Ottawa, ON, Canada
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11
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Haarbauer-Krupa J, Pugh MJ, Prager EM, Harmon N, Wolfe J, Yaffe K. Epidemiology of Chronic Effects of Traumatic Brain Injury. J Neurotrauma 2021; 38:3235-3247. [PMID: 33947273 PMCID: PMC9122127 DOI: 10.1089/neu.2021.0062] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although many patients diagnosed with traumatic brain injury (TBI), particularly mild TBI, recover from their symptoms within a few weeks, a small but meaningful subset experience symptoms that persist for months or years after injury and significantly impact quality of life for the person and their family. Factors associated with an increased likelihood of negative TBI outcomes include not only characteristics of the injury and injury mechanism, but also the person’s age, pre-injury status, comorbid conditions, environment, and propensity for resilience. In this article, as part of the Brain Trauma Blueprint: TBI State of the Science framework, we examine the epidemiology of long-term outcomes of TBI, including incidence, prevalence, and risk factors. We identify the need for increased longitudinal, global, standardized, and validated assessments on incidence, recovery, and treatments, as well as standardized assessments of the influence of genetics, race, ethnicity, sex, and environment on TBI outcomes. By identifying how epidemiological factors contribute to TBI outcomes in different groups of persons and potentially impact differential disease progression, we can guide investigators and clinicians toward more-precise patient diagnosis, along with tailored management, and improve clinical trial designs, data evaluation, and patient selection criteria.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, Utah, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, San Francisco, California, USA
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12
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Lange RT, Lippa SM, Brickell TA, Yeh PH, Ollinger J, Wright M, Driscoll A, Sullivan J, Braatz S, Gartner R, Barnhart E, French LM. Post-Traumatic Stress Disorder Is Associated with Neuropsychological Outcome but Not White Matter Integrity after Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:63-73. [PMID: 33395374 DOI: 10.1089/neu.2019.6852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to examine neuropsychological functioning and white matter integrity, in service members and veterans (SMVs) after mild traumatic brain injury (MTBI), with versus without post-traumatic stress disorder (PTSD). Participants were 116 U.S. military SMVs, prospectively enrolled from the Walter Reed National Military Medical Center (Bethesda, MD), who had sustained an MTBI (n = 86) or an injury without TBI (i.e., Injured Control [IC]; n = 30). Participants completed a battery of neuropsychological measures (neurobehavioral and -cognitive), as well as diffusion tensor imaging (DTI) of the brain, on average 6 years post-injury. Based on diagnostic criteria for PTSD, participants in the MTBI group were classified into two subgroups: MTBI/PTSD-Present (n = 21) and MTBI/PTSD-Absent (n = 65). Participants in the IC group were included only if they were classified as PTSD-Absent. The MTBI/PTSD-Present group had a significantly higher number of self-reported symptoms on all neurobehavioral measures (e.g., depression), and lower scores on more than half of the neurocognitive domains (e.g., processing speed), compared to the MTBI/PTSD-Absent and IC/PTSD-Absent groups. There were no significant group differences for the vast majority of DTI measures, with the exception of a handful of regions (i.e., superior longitudinal fascicle and superior thalamic radiation). These results suggest that there is 1) a strong relationship between PTSD and poor neuropsychological outcome after MTBI and 2) a lack of a relationship between PTSD and white matter integrity, as measured by DTI, after MTBI. Concurrent PTSD and MTBI should be considered a risk factor for poor neuropsychological outcome that requires early intervention.
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Affiliation(s)
- Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Megan Wright
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Angela Driscoll
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jamie Sullivan
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Samantha Braatz
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rachel Gartner
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth Barnhart
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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Agtarap SD, Campbell-Sills L, Jain S, Sun X, Dikmen S, Levin H, McCrea MA, Mukherjee P, Nelson LD, Temkin N, Yuh EL, Giacino JT, Manley GT, Stein MB. Satisfaction with Life after Mild Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2020; 38:546-554. [PMID: 33107371 DOI: 10.1089/neu.2020.7055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Identifying the principal determinants of life satisfaction following mild TBI (mTBI) may inform efforts to improve subjective well-being in this population. We examined life satisfaction among participants in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study who presented with mTBI (Glasgow Coma Scale [GCS] score = 13-15; n = 1152). An L1-regularization path algorithm was used to select optimal sets of baseline and concurrent symptom measures for prediction of scores on the Satisfaction with Life Scale (SWLS) at 2 weeks and 3, 6, and 12 months post-injury. Multi-variable linear regression models (all n = 744-894) were then fit to evaluate associations between the empirically selected predictors and SWLS scores at each follow-up visit. Results indicated that emotional post-TBI symptoms (all b = -1.27 to -0.77, all p < 0.05), anhedonia (all b = -1.59 to -1.08, all p < 0.01), and pain interference (all b = -1.38 to -0.89, all p < 0.001) contributed to the prediction of lower SWLS scores at all follow-ups. Insomnia predicted lower SWLS scores at 2 weeks, 3 months, and 6 months (all b = -1.11 to -0.83, all ps < 0.01); and negative affect predicted lower SWLS scores at 2 weeks, 3 months, and 12 months (all b = -1.38 to -0.80, all p < 0.005). Other post-TBI symptom domains and baseline socio-demographic, injury-related, and clinical characteristics did not emerge as robust predictors of SWLS scores during the year after mTBI. Efforts to improve satisfaction with life following mTBI may benefit from a focus on the detection and treatment of affective symptoms, pain, and insomnia. The results reinforce the need for tailoring of evidence-based treatments for these conditions to maximize efficacy in patients with mTBI.
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Affiliation(s)
- Stephanie D Agtarap
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Services, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nancy Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington, USA
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Services, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA.,Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA
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14
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Fisher LB, Bomyea J, Thomas G, Cheung JC, He F, Jain S, Flashman LA, Andaluz N, Coimbra R, George MS, Grant GA, Marx CE, McAllister TW, Shutter L, Lang AJ, Stein MB, Zafonte RD. Contributions of posttraumatic stress disorder (PTSD) and mild TBI (mTBI) history to suicidality in the INTRuST consortium. Brain Inj 2020; 34:1339-1349. [PMID: 32811203 DOI: 10.1080/02699052.2020.1807054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Mild TBI (mTBI) and posttraumatic stress disorder (PTSD) are independent risk factors for suicidal behaviour (SB). Further, co-occurring mTBI and PTSD increase one's risk for negative health and psychiatric outcomes. However, little research has examined the role of comorbid mTBI and PTSD on suicide risk. METHODS The present study utilized data from the Injury and TRaUmatic STress (INTRuST) Consortium to examine the prevalence of suicidal ideation (SI) and behaviours among four groups: 1) comorbid mTBI+PTSD, 2) PTSD only, 3) mTBI only, and 4) healthy controls. RESULTS Prevalence of lifetime SI, current SI, and lifetime SB for individuals with mTBI+PTSD was 40%, 25%, and 19%, respectively. Prevalence of lifetime SI, current SI, and lifetime SB for individuals with PTSD only was 29%, 11%, and 11%, respectively. Prevalence of lifetime SI, current SI, and lifetime SB for individuals with mTBI only was 14%, 1%, and 2%, respectively. Group comparisons showed that individuals with mTBI alone experienced elevated rates of lifetime SI compared to healthy controls. History of mTBI did not add significantly to risk for suicidal ideation and behaviour beyond what is accounted for by PTSD. CONCLUSION Findings suggest that PTSD seems to be driving risk for suicidal behaviour.
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Affiliation(s)
- Lauren B Fisher
- Department of Psychiatry, Harvard Medical School , Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Jessica Bomyea
- VA San Diego Center of Excellence for Stress and Mental Health , San Diego, California, USA.,Department of Psychiatry, University of California San Diego , La Jolla, California, USA
| | - Garrett Thomas
- Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Joey C Cheung
- Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Feng He
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Laura A Flashman
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Dartmouth Geisel School of Medicine at Dartmouth , Hanover, New Hampshire, USA
| | - Norberto Andaluz
- Department of Neurological Surgery, University of Louisville , Louisville, Kentucky, USA
| | - Raul Coimbra
- Department of Surgery, Riverside University Health System , Moreno Valley, California, USA
| | - Mark S George
- Psychiatry Division, Ralph H. Johnson VA Medical Center , Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina , Charleston, South Carolina, USA
| | - Gerald A Grant
- Department of Neurology and Neurosciences, Stanford University Medical Center , Stanford, California, USA
| | - Christine E Marx
- Durham VA Medical Center , Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University , Durham, North Carolina, USA
| | - Thomas W McAllister
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Dartmouth Geisel School of Medicine at Dartmouth , Hanover, New Hampshire, USA.,Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana, USA
| | - Lori Shutter
- Department of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Ariel J Lang
- VA San Diego Center of Excellence for Stress and Mental Health , San Diego, California, USA.,Department of Psychiatry, University of California San Diego , La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego , La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital, Massachusetts General Hospital, and Harvard Medical School , Boston, Massachusetts, USA.,Massachusetts General Hospital for Children Sports Concussion Program , Boston, Massachusetts, USA.,MGH Red Sox Foundation Home Base Program , Boston, Massachusetts, USA
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15
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Lange RT, French LM, Lippa SM, Bailie JM, Brickell TA. Posttraumatic Stress Disorder is a Stronger Predictor of Long-Term Neurobehavioral Outcomes Than Traumatic Brain Injury Severity. J Trauma Stress 2020; 33:318-329. [PMID: 32379932 DOI: 10.1002/jts.22480] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 04/05/2019] [Indexed: 11/11/2022]
Abstract
Concurrent posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) is common in military populations. The purpose of this study was to examine long-term neurobehavioral outcomes in service members and veterans (SMVs) with versus without PTSD symptoms following TBI of all severities. Participants were 536 SMVs prospectively enrolled from three military medical treatment facilities who were recruited into three experimental groups: TBI, injured controls (IC), and noninjured controls (NIC). Participants completed the PTSD Checklist, Neurobehavioral Symptom Inventory, and the TBI-Quality of Life (TBI-QOL) and were divided into six subgroups based on the three experimental categories, two PTSD categories (i.e., present vs. absent), and two broad TBI severity categories (unMTBI, which included uncomplicated mild TBI; and smcTBI, which included severe TBI, moderate TBI, and complicated mild TBI): (a) NIC/PTSD-absent, (b) IC/PTSD-absent, (c) unMTBI/PTSD-absent, (d) unMTBI/PTSD-present, (e) smcTBI/PTSD-absent, and (f) smcTBI/PTSD-present. There were significant main effects across the six groups for all TBI-QOL measures, ps < .001. Select pairwise comparisons revealed significantly lower scores, p < .001, on all TBI-QOL measures in the PTSD-present groups when compared to the PTSD-absent groups within the same TBI severity classification, ds = 0.90-2.11. In contrast, when controlling for PTSD, there were no significant differences among the TBI severity groups for any TBI-QOL measures. These results provide support for the strong influence of PTSD but not TBI severity on neurobehavioral outcomes following TBI. Concurrent PTSD and TBI of all severities should be considered a risk factor for poor long-term neurobehavioral outcomes that require ongoing monitoring.
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Affiliation(s)
- Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sara M Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Jason M Bailie
- Defense and Veterans Brain Injury Center, Naval Hospital Camp Pendleton, California, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
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16
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Van Praag DLG, Fardzadeh HE, Covic A, Maas AIR, von Steinbüchel N. Preliminary validation of the Dutch version of the Posttraumatic stress disorder checklist for DSM-5 (PCL-5) after traumatic brain injury in a civilian population. PLoS One 2020; 15:e0231857. [PMID: 32310970 PMCID: PMC7170250 DOI: 10.1371/journal.pone.0231857] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
The Posttraumatic stress disorder checklist (PCL) is the most widely used questionnaire to screen for symptoms of posttraumatic stress disorder (PTSD), based on the Diagnostic and Statistical manual of Mental disorders (DSM-IV) criteria. In the latest edition of the DSM (DSM-5), the criteria for PTSD were revised leading to the development of the PCL-5. So far, there is no validated Dutch version of the PCL-5. The aim of this study is to determine psychometric characteristics of the Dutch translation and linguistic validation of the PCL-5 and to evaluate internal consistency, criterion and structural validity. In a population of 495 civilian, traumatic brain injury patients, the PCL-5, the Generalized anxiety disorder questionnaire and the Depression scale of the Patient health questionnaire were administered. The PCL-5 was translated in Dutch following a strict procedure of linguistic validation and cognitive debriefing. Results show an excellent internal consistency and high criterion validity. Confirmatory factor analysis demonstrated a good fit for the four-factor DSM-5 model, but a superior fit for the six-factor Anhedonia model and the seven-factor Hybrid model, similar to the English version of the PCL-5. Preliminary validation of the Dutch translation of the PCL-5 was proven to be psychometrically sound and can be used for clinical and academic purposes, specifically for TBI patients. Future research should examine concurrent and discriminant validity for the Dutch translation in broader populations at risk for PTSD, and include a structured interview to evaluate diagnostic utility.
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Affiliation(s)
- Dominique L. G. Van Praag
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
- * E-mail:
| | - Haghish Ebad Fardzadeh
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/Georg-August-University, Göttingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/Georg-August-University, Göttingen, Germany
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/Georg-August-University, Göttingen, Germany
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17
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Yue JK, Upadhyayula PS, Avalos LN, Phelps RRL, Suen CG, Cage TA. Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations. J Neurosci Rural Pract 2020; 11:23-33. [PMID: 32214697 PMCID: PMC7092729 DOI: 10.1055/s-0039-3402581] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Mild-traumatic brain injury (mTBI) and concussions cause significant morbidity. To date, synthesis of specific health care disparities and gaps in care for rural mTBI/concussion patients remains needed. Methods A comprehensive literature search was performed using PubMed database for English articles with keywords "rural" and ("concussion" or "mild traumatic brain injury") from 1991 to 2019. Eighteen articles focusing on rural epidemiology ( n = 5), management/cost ( n = 5), military ( n = 2), and concussion prevention/return to play ( n = 6) were included. Results mTBI/concussion incidence was higher in rural compared with urban areas. Compared with urban patients, rural patients were at increased risk for vehicular injuries, lifetime number of concussions, admissions for observation without neuroimaging, and injury-related costs. Rural patients were less likely to utilize ambulatory and mental health services following mTBI/concussion. Rural secondary schools had decreased access to certified personnel for concussion evaluation, and decreased use of standardized assessment instruments/neurocognitive testing. While school coaches were aware of return-to-play laws, mTBI/concussion education rates for athletes and parents were suboptimal in both settings. Rural veterans were at increased risk for postconcussive symptoms and posttraumatic stress. Telemedicine in rural/low-resource areas is an emerging tool for rapid evaluation, triage, and follow-up. Conclusions Rural patients are at unique risk for mTBI/concussions and health care costs. Barriers to care include lower socioeconomic status, longer distances to regional medical center, and decreased availability of neuroimaging and consultants. Due to socioeconomic and distance barriers, rural schools are less able to recruit personnel certified for concussion evaluation. Telemedicine is an emerging tool for remote triage and evaluation.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, United States.,Department of Neurological Surgery, University of California San Diego, San Diego, California, United States
| | - Lauro N Avalos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States
| | - Ryan R L Phelps
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States
| | - Catherine G Suen
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States.,Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Tene A Cage
- Department of Neurological Surgery, Stanford University School of Medicine, Stanford, California, United States
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18
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Escolas SM, Luton M, Ferdosi H, Chavez BD, Engel SD. Traumatic Brain Injuries: Unreported and Untreated in an Army Population. Mil Med 2020; 185:154-160. [DOI: 10.1093/milmed/usz259] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Introduction
In 2008, it was reported that 19.5% of service members previously deployed experienced a mild traumatic brain injury (mTBI). Fifty-seven percent of those did not seek medical care. It was suggested that concerns with seeking care involved confidentiality and career issues. Objective: This study addressed mTBI history, medical treatment history, and stigmas associated with mTBI/concussion.
Materials and Methods
An anonymous questionnaire was developed. Data collection occurred throughout March 2018 in conjunction with Brain Injury Awareness Month activities.
Results
All 5,174 volunteers were Army; 86% male; 87% were between 18 and 34 years old; 89% had <14 years in the military; 35% had a combat deployment; and 10% reported having one or more mTBIs in their military careers. Of the Soldiers who reported a concussion, 52% sought medical care. Of those not seeking care, 64% reported they did not think the injury required care, followed by 18% fearing negative impact on their career. Twenty-eight percent who experienced an mTBI versus 11% who have not reported that there is a stigma associated with an mTBI.
Conclusions
Soldiers sometimes failed to report their suspected concussions and did not seek medical care. Educational efforts may increase reporting of and medical screening for potentially concussive events. Future research to determine the ramifications of unreported and untreated mTBIs/concussions is recommended.
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Affiliation(s)
- Sandra M Escolas
- Defense and Veterans Brain Injury Center, 1335 East-West Highway, Ste 6-100, Silver Spring, MD 20910
- General Dynamics Information Technology, 3211 Jermantown Road, Fairfax, VA 22030
- Fort Hood Intrepid Spirit Center, Bldg 36029 58th Street, Fort Hood, TX 76544
| | - Margie Luton
- Defense and Veterans Brain Injury Center, 1335 East-West Highway, Ste 6-100, Silver Spring, MD 20910
- General Dynamics Information Technology, 3211 Jermantown Road, Fairfax, VA 22030
- Fort Hood Intrepid Spirit Center, Bldg 36029 58th Street, Fort Hood, TX 76544
| | - Hamid Ferdosi
- Defense and Veterans Brain Injury Center, 1335 East-West Highway, Ste 6-100, Silver Spring, MD 20910
- General Dynamics Information Technology, 3211 Jermantown Road, Fairfax, VA 22030
| | - Bianca D Chavez
- Defense and Veterans Brain Injury Center, 1335 East-West Highway, Ste 6-100, Silver Spring, MD 20910
- General Dynamics Information Technology, 3211 Jermantown Road, Fairfax, VA 22030
- Traumatic Brain Injury Clinic, Bldg 2496, Ricker Road, Fort Bliss, TX 79916
| | - Scot D Engel
- Defense and Veterans Brain Injury Center, 1335 East-West Highway, Ste 6-100, Silver Spring, MD 20910
- Fort Hood Intrepid Spirit Center, Bldg 36029 58th Street, Fort Hood, TX 76544
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19
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Patient-reported Outcomes at 6 to 12 Months Among Survivors of Firearm Injury in the United States. Ann Surg 2020; 274:e1247-e1251. [DOI: 10.1097/sla.0000000000003797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Van Praag DL, Cnossen MC, Polinder S, Wilson L, Maas AI. Post-Traumatic Stress Disorder after Civilian Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prevalence Rates. J Neurotrauma 2019; 36:3220-3232. [PMID: 31238819 PMCID: PMC6857464 DOI: 10.1089/neu.2018.5759] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a commonly diagnosed psychiatric disorder following traumatic brain injury (TBI). Much research on PTSD and TBI has focused on military conflict settings. Less is known about PTSD in civilian TBI. We conducted a systematic review and meta-analysis on the prevalence of PTSD after mild and moderate/severe TBI in civilian populations. We further aimed to explore the influence of methodological quality and assessment methods. A systematic literature search was performed on studies reporting on PTSD in civilian TBI, excluding studies on military populations. The risk of bias was assessed using the MORE (Methodological evaluation of Observational REsearch) checklist. Meta-analysis was conducted for overall prevalence rates for PTSD with sensitivity analyses for the severity of TBI. Fifty-two studies were included, of which 31 were graded as low risk of bias. Prevalence rates of PTSD in low risk of bias studies varied widely (2.6-36%) with a pooled prevalence rate of 15.6%. Pooled prevalence rates of PTSD for mild TBI (13.5%, 95% confidence interval [CI]: 11.7-15.3; I2 = 2%) did not differ from moderate/severe TBI (11.8, 95% CI: 7.5-16.1; I2 = 63%). Similar rates were reported in studies using different approaches and times of assessment. Although most studies that compared participants with TBI with trauma patients and healthy controls found no difference in prevalence rates of PTSD, a meta-analysis across studies revealed a higher prevalence of PTSD in patients with TBI (odds ratio [OR]: 1.73, 95% CI: 1.21-2.47). This review highlights variability between studies and emphasizes the need for higher-quality studies. Further research is warranted to determine risk factors for the development of PTSD after TBI.
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Affiliation(s)
- Dominique L.G. Van Praag
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maryse C. Cnossen
- Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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21
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Jaramillo S, Suffoletto B, Callaway C, Pacella-LaBarbara M. Early Screening for Posttraumatic Stress Disorder and Depression Among Injured Emergency Department Patients: A Feasibility Study. Acad Emerg Med 2019; 26:1232-1244. [PMID: 31179590 PMCID: PMC7294865 DOI: 10.1111/acem.13816] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few emergency departments (EDs) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive and brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks postinjury. METHODS In the EDs of two Level I trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and trauma-specific QOL (T-QoL). RESULTS Our retained sample at 6 weeks was 84 adults (51.2% male; mean ± SD age = 33 ± 11.88 years); 38% screened positive for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a positive ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92 to 15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20 to 7.74), respectively. Further, a positive ED screen for depression (p = 0.043, 95% CI = -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL. CONCLUSIONS These results suggest that it is feasible to identify patients at risk for postinjury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring.
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Affiliation(s)
- Stephany Jaramillo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maria Pacella-LaBarbara
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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22
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Yue JK, Levin HS, Suen CG, Morrissey MR, Runyon SJ, Winkler EA, Puffer RC, Deng H, Robinson CK, Rick JW, Phelps RRL, Sharma S, Taylor SR, Vassar MJ, Cnossen MC, Lingsma HF, Gardner RC, Temkin NR, Barber J, Dikmen SS, Yuh EL, Mukherjee P, Stein MB, Cage TA, Valadka AB, Okonkwo DO, Manley GT. Age and sex-mediated differences in six-month outcomes after mild traumatic brain injury in young adults: a TRACK-TBI study. Neurol Res 2019; 41:609-623. [PMID: 31007155 DOI: 10.1080/01616412.2019.1602312] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Risk factors for young adults with mTBI are not well understood. Improved understanding of age and sex as risk factors for impaired six-month outcomes in young adults is needed. Methods: Young adult mTBI subjects aged 18-39 years (18-29y; 30-39y) with six-month outcomes were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Multivariable regressions were performed for outcomes with age, sex, and the interaction factor age-group*sex as variables of interest, controlling for demographic and injury variables. Mean-differences (B) and 95% CIs are reported. Results: One hundred mTBI subjects (18-29y, 70%; 30-39y, 30%; male, 71%; female, 29%) met inclusion criteria. On multivariable analysis, age-group*sex was associated with six-month post-traumatic stress disorder (PTSD; PTSD Checklist-Civilian version); compared with female 30-39y, female 18-29y (B= -19.55 [-26.54, -4.45]), male 18-29y (B= -19.70 [-30.07, -9.33]), and male 30-39y (B= -15.49 [-26.54, -4.45]) were associated with decreased PTSD symptomatology. Female sex was associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended (GOSE): B= -0.6 [1.0, -0.1]). Comparatively, 30-39y scored higher on six-month nonverbal processing speed (Wechsler Adult Intelligence Scale-Processing Speed Index (WAIS-PSI); B= 11.88, 95% CI [1.66, 22.09]). Conclusions: Following mTBI, young adults aged 18-29y and 30-39y may have different risks for impairment. Sex may interact with age for PTSD symptomatology, with females 30-39y at highest risk. These results may be attributable to cortical maturation, biological response, social modifiers, and/or differential self-report. Confirmation in larger samples is needed; however, prevention and rehabilitation/counseling strategies after mTBI should likely be tailored for age and sex.
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Affiliation(s)
- John K Yue
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Harvey S Levin
- c Departments of Neurology and Neurosurgery , Baylor College of Medicine , Houston , TX , USA
| | - Catherine G Suen
- d Department of Neurology , University of Utah , Salt Lake City , UT , USA
| | - Molly Rose Morrissey
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sarah J Runyon
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ethan A Winkler
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ross C Puffer
- e Department of Neurological Surgery , Mayo Clinic , Rochester , MN , USA.,f Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Hansen Deng
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Caitlin K Robinson
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Jonathan W Rick
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ryan R L Phelps
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sourabh Sharma
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sabrina R Taylor
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Mary J Vassar
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Maryse C Cnossen
- g Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Hester F Lingsma
- g Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Raquel C Gardner
- h Department of Neurology , University of California San Francisco , San Francisco , CA , USA.,i Department of Neurology , Veterans Affairs Medical Center , San Francisco , CA , USA
| | - Nancy R Temkin
- j Departments of Neurological Surgery and Biostatistics , University of Washington , Seattle , WA , USA
| | - Jason Barber
- j Departments of Neurological Surgery and Biostatistics , University of Washington , Seattle , WA , USA
| | - Sureyya S Dikmen
- k Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Esther L Yuh
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,l Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Pratik Mukherjee
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,l Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Murray B Stein
- m Departments of Psychiatry and Family Medicine , University of California San Diego , San Diego , CA , USA
| | - Tene A Cage
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Alex B Valadka
- n Department of Neurological Surgery , Virginia Commonwealth University , Richmond , VA , USA
| | - David O Okonkwo
- f Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Geoffrey T Manley
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
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- o TRACK-TBI Investigators are listed below in alphabetical order by last name
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23
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Lange RT, Lippa SM, French LM, Bailie JM, Gartner RL, Driscoll AE, Wright MM, Sullivan JK, Varbedian NV, Barnhart EA, Holzinger JB, Schaper AL, Reese MA, Brandler BJ, Camelo-Lopez V, Brickell TA. Long-term neurobehavioural symptom reporting following mild, moderate, severe, and penetrating traumatic brain injury in U.S. military service members. Neuropsychol Rehabil 2019; 30:1762-1785. [DOI: 10.1080/09602011.2019.1604385] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rael T. Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Sara M. Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Louis M. French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Naval Hospital Camp Pendleton, CA, USA
| | - Rachel L. Gartner
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Angela E. Driscoll
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Megan M. Wright
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Jamie K. Sullivan
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Nicole V. Varbedian
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Elizabeth A. Barnhart
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Jayne B. Holzinger
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Ashley L. Schaper
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Maryetta A. Reese
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Brian J. Brandler
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Vanessa Camelo-Lopez
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Tracey A. Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
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24
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Ferdosi H, Schwab KA, Metti A, Brenner LA, Terrio H, Pazdan RM, Cole WR, Scher AI. Trajectory of Postconcussive Symptoms 12 Months After Deployment in Soldiers With and Without Mild Traumatic Brain Injury: Warrior Strong Study. Am J Epidemiol 2019; 188:77-86. [PMID: 30203085 DOI: 10.1093/aje/kwy199] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022] Open
Abstract
We analyzed data from a cohort of recently deployed soldiers from 2 US Army bases, Fort Carson and Fort Bragg (2009 to 2015). Soldiers with and without a recent history of mild traumatic brain injury (mTBI) on deployment were evaluated within days of return and at 3, 6, and 12 months. Those with mTBI were more likely than those without to endorse ≥1 postconcussive symptom as "severe" and/or "very severe" (47% vs. 21%, baseline; adjusted relative risk (RR) = 1.71, 95% confidence interval: 1.51, 1.93, all time points), which remained significant after adjusting for posttraumatic stress disorder (adjusted RR = 1.34, 95% confidence interval: 1.20, 1.50). Prevalence and relative risks for 3 of the most common baseline symptoms remained constant over time: sleep problems (RR = 2.19), forgetfulness (RR = 2.56), and irritability (RR = 2.73). The pattern was slightly different for headache (baseline, RR = 3.44; 12 months, RR = 3.26), due to increased prevalence of headache in those without mTBI. The prevalence of clinically relevant postconcussive symptoms remained relatively constant over 1 year of follow-up, whether or not symptoms were associated with concussion. Service members with recent mTBI reported more symptoms than those without at all time points.
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Affiliation(s)
- Hamid Ferdosi
- Defense and Veterans Brain Injury Center, TBI Center of Excellence, Silver Spring, Maryland
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Karen A Schwab
- Defense and Veterans Brain Injury Center, TBI Center of Excellence, Silver Spring, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Andrea Metti
- Metti Consulting Company, Pittsburgh, Pennsylvania
| | - Lisa A Brenner
- Veterans Health Administration Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, Colorado
- Marcus Institute for Brain Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Heidi Terrio
- Defense and Veterans Brain Injury Center, Evans Army Community Hospital, Colorado Springs, Colorado
| | - Renee M Pazdan
- Defense and Veterans Brain Injury Center, Evans Army Community Hospital, Colorado Springs, Colorado
| | - Wesley R Cole
- Defense and Veterans Brain Injury Center, Fort Bragg, North Carolina
| | - Ann I Scher
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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25
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Hsia RY, Markowitz AJ, Lin F, Guo J, Madhok DY, Manley GT. Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions. BMJ Open 2018; 8:e022297. [PMID: 30552250 PMCID: PMC6303631 DOI: 10.1136/bmjopen-2018-022297] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs. DESIGN We performed a retrospective cohort study. SETTING We analysed non-public patient-level data from California's Office of Statewide Health Planning and Development for years 2005 to 2014. PARTICIPANTS We identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI. PRIMARY AND SECONDARY OUTCOME MEASURES Our main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge. RESULTS We found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346-487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission. CONCLUSIONS The large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI.
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Affiliation(s)
- Renee Y Hsia
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Amy J Markowitz
- Brain and Spinal Injury Center (BASIC), University of California, San Francisco, San Francisco, California, USA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Joanna Guo
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Debbie Y Madhok
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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26
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Paredes Molina CS, Berry S, Nielsen A, Winfield R. PTSD in civilian populations after hospitalization following traumatic injury: A comprehensive review. Am J Surg 2018; 216:745-753. [PMID: 30103902 DOI: 10.1016/j.amjsurg.2018.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Injuries and their comorbidities affect victims far beyond their physical recovery period. Some study-measures show that more than half of patients hospitalized for a traumatic injury suffer from Acute Stress Disorder, alcohol dependence, and recurrent trauma. Overall, this literature review serves to review risk factors for PTSD, screening tools, follow-up strategies, and gaps in the literature for achieving feasible patient-centered interventions for the prevention of PTSD after a traumatic injury. DATA SOURCES A literature review was performed from August 1, 2017 to March 19, 2018, from 3 Databases: PubMed, CINAHL and Cochrane, with keywords: "PTSD", "Post-traumatic Stress Disorder", "Civilians", "Traumatic", "Injury", "Follow-up", "Treatment", "Referral", "surgery", "surgical", "Intervention", and "Insured", "underinsured". CONCLUSIONS Reported risk factors for PTSD were: prior psychiatric disorder, gunshots, and lack of social support. Most articles use the Posttraumatic Stress Disorder Checklist - Civilian version. Follow-up strategies mainly focus on multidisciplinary intervention protocols, including social workers, behavioral health specialists, and psychiatrists. Finally, gaps in the literature show the need for bilingual/bicultural patient-centered care for elderly, diverse ethnic backgrounds, and insured vs. uninsured patients.
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Affiliation(s)
| | - Stepheny Berry
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Alexandra Nielsen
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Robert Winfield
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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27
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Noncoding RNAs: Stress, Glucocorticoids, and Posttraumatic Stress Disorder. Biol Psychiatry 2018; 83:849-865. [PMID: 29559087 DOI: 10.1016/j.biopsych.2018.01.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 12/12/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a pathologic response to trauma that impacts ∼8% of the population and is highly comorbid with other disorders, such as traumatic brain injury. PTSD affects multiple biological systems throughout the body, including the hypothalamic-pituitary-adrenal axis, cortical function, and the immune system, and while the study of the biological underpinnings of PTSD and related disorders are numerous, the roles of noncoding RNAs (ncRNAs) are just emerging. Moreover, deep sequencing has revealed that ncRNAs represent most of the transcribed mammalian genome. Here, we present developing evidence that ncRNAs are involved in critical aspects of PTSD pathophysiology. In that regard, we summarize the roles of three classes of ncRNAs in PTSD and related disorders: microRNAs, long-noncoding RNAs, and retrotransposons. This review evaluates findings from both animal and human studies with a special focus on the role of ncRNAs in hypothalamic-pituitary-adrenal axis abnormalities and glucocorticoid dysfunction in PTSD and traumatic brain injury. We conclude that ncRNAs may prove to be useful biomarkers to facilitate personalized medicines for trauma-related brain disorders.
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28
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Affiliation(s)
- Davin K Quinn
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
| | - Andrew R Mayer
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
| | - Christina L Master
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
| | - Jesse R Fann
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
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Labudda K, Illies D, Bien CG, Neuner F. Postepileptic seizure PTSD: A very rare psychiatric condition in patients with epilepsy. Epilepsy Behav 2018; 78:219-225. [PMID: 29122493 DOI: 10.1016/j.yebeh.2017.08.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE It has been shown that relatives of patients with epilepsy could experience a seizure as a traumatic event followed by a posttraumatic stress disorder (PTSD). In one questionnaire study, 51% of the patients with epilepsy were reported to have a PTSD caused by a traumatic seizure, termed postepileptic seizure PTSD by the authors. However, it remained unclear whether these patients had further psychiatric comorbidities and if certain seizure features may foster the development of the proposed epilepsy-specific PTSD. METHODS We conducted a structured clinical interview assessing psychiatric disorders in 120 patients with difficult-to-treat epilepsies. We also used a modified version of the Posttraumatic Stress Diagnostic Scale conducted as an interview to assess the number of patients who fulfilled the criteria for a PTSD caused by an epileptic seizure. We additionally compared certain features of traumatic versus nontraumatic seizures. RESULTS Fifty of the 120 patients identified a seizure that fulfilled the criteria for a traumatic event, whereas 28 patients identified a worst seizure not meeting the trauma definition. Six patients fulfilled all PTSD criteria caused by a traumatic seizure. However, three of these patients also had a regular PTSD, and in two further patients, the results of the clinical interview suggested that the PTSD-like symptoms could be better explained by an adjustment disorder. We could not identify seizure characteristics differentiating traumatic from nontraumatic seizures. CONCLUSION Our results showed that it is recommendable to conceptualize an epileptic seizure as being potentially traumatic in nature when assessing PTSD in patients with epilepsy, although we could not identify specific characteristics that could differentiate between traumatic and nontraumatic seizures. However, while using interview-based psychiatric assessment, we found a very low rate of a postepileptic seizure PTSD. It is worth conducting a comprehensive psychiatric diagnostic interview to differentiate PTSD-like symptoms from other comorbidities, such as epilepsy-related adjustment disorder.
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Affiliation(s)
- Kirsten Labudda
- Bielefeld University, Department of Psychology, Bielefeld, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany.
| | - Dominik Illies
- Bielefeld University, Department of Psychology, Bielefeld, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
| | | | - Frank Neuner
- Bielefeld University, Department of Psychology, Bielefeld, Germany
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Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime AC, Ercole A, van Essen TA, Feigin VL, Gao G, Giacino J, Gonzalez-Lara LE, Gruen RL, Gupta D, Hartings JA, Hill S, Jiang JY, Ketharanathan N, Kompanje EJO, Lanyon L, Laureys S, Lecky F, Levin H, Lingsma HF, Maegele M, Majdan M, Manley G, Marsteller J, Mascia L, McFadyen C, Mondello S, Newcombe V, Palotie A, Parizel PM, Peul W, Piercy J, Polinder S, Puybasset L, Rasmussen TE, Rossaint R, Smielewski P, Söderberg J, Stanworth SJ, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Synnot A, Te Ao B, Tenovuo O, Theadom A, Tibboel D, Videtta W, Wang KKW, Williams WH, Wilson L, Yaffe K, Adams H, Agnoletti V, Allanson J, Amrein K, Andaluz N, Anke A, Antoni A, van As AB, Audibert G, Azaševac A, Azouvi P, Azzolini ML, Baciu C, Badenes R, Barlow KM, Bartels R, Bauerfeind U, Beauchamp M, Beer D, Beer R, Belda FJ, Bellander BM, Bellier R, Benali H, Benard T, Beqiri V, Beretta L, Bernard F, Bertolini G, Bilotta F, Blaabjerg M, den Boogert H, Boutis K, Bouzat P, Brooks B, Brorsson C, Bullinger M, Burns E, Calappi E, Cameron P, Carise E, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Christie B, Cnossen M, Coles J, Collett J, Della Corte F, Craig W, Csato G, Csomos A, Curry N, Dahyot-Fizelier C, Dawes H, DeMatteo C, Depreitere B, Dewey D, van Dijck J, Đilvesi Đ, Dippel D, Dizdarevic K, Donoghue E, Duek O, Dulière GL, Dzeko A, Eapen G, Emery CA, English S, Esser P, Ezer E, Fabricius M, Feng J, Fergusson D, Figaji A, Fleming J, Foks K, Francony G, Freedman S, Freo U, Frisvold SK, Gagnon I, Galanaud D, Gantner D, Giraud B, Glocker B, Golubovic J, Gómez López PA, Gordon WA, Gradisek P, Gravel J, Griesdale D, Grossi F, Haagsma JA, Håberg AK, Haitsma I, Van Hecke W, Helbok R, Helseth E, van Heugten C, Hoedemaekers C, Höfer S, Horton L, Hui J, Huijben JA, Hutchinson PJ, Jacobs B, van der Jagt M, Jankowski S, Janssens K, Jelaca B, Jones KM, Kamnitsas K, Kaps R, Karan M, Katila A, Kaukonen KM, De Keyser V, Kivisaari R, Kolias AG, Kolumbán B, Kolundžija K, Kondziella D, Koskinen LO, Kovács N, Kramer A, Kutsogiannis D, Kyprianou T, Lagares A, Lamontagne F, Latini R, Lauzier F, Lazar I, Ledig C, Lefering R, Legrand V, Levi L, Lightfoot R, Lozano A, MacDonald S, Major S, Manara A, Manhes P, Maréchal H, Martino C, Masala A, Masson S, Mattern J, McFadyen B, McMahon C, Meade M, Melegh B, Menovsky T, Moore L, Morgado Correia M, Morganti-Kossmann MC, Muehlan H, Mukherjee P, Murray L, van der Naalt J, Negru A, Nelson D, Nieboer D, Noirhomme Q, Nyirádi J, Oddo M, Okonkwo DO, Oldenbeuving AW, Ortolano F, Osmond M, Payen JF, Perlbarg V, Persona P, Pichon N, Piippo-Karjalainen A, Pili-Floury S, Pirinen M, Ple H, Poca MA, Posti J, Van Praag D, Ptito A, Radoi A, Ragauskas A, Raj R, Real RGL, Reed N, Rhodes J, Robertson C, Rocka S, Røe C, Røise O, Roks G, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossi S, Rueckert D, de Ruiter GCW, Sacchi M, Sahakian BJ, Sahuquillo J, Sakowitz O, Salvato G, Sánchez-Porras R, Sándor J, Sangha G, Schäfer N, Schmidt S, Schneider KJ, Schnyer D, Schöhl H, Schoonman GG, Schou RF, Sir Ö, Skandsen T, Smeets D, Sorinola A, Stamatakis E, Stevanovic A, Stevens RD, Sundström N, Taccone FS, Takala R, Tanskanen P, Taylor MS, Telgmann R, Temkin N, Teodorani G, Thomas M, Tolias CM, Trapani T, Turgeon A, Vajkoczy P, Valadka AB, Valeinis E, Vallance S, Vámos Z, Vargiolu A, Vega E, Verheyden J, Vik A, Vilcinis R, Vleggeert-Lankamp C, Vogt L, Volovici V, Voormolen DC, Vulekovic P, Vande Vyvere T, Van Waesberghe J, Wessels L, Wildschut E, Williams G, Winkler MKL, Wolf S, Wood G, Xirouchaki N, Younsi A, Zaaroor M, Zelinkova V, Zemek R, Zumbo F. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16:987-1048. [DOI: 10.1016/s1474-4422(17)30371-x] [Citation(s) in RCA: 822] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
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Mayer AR, Quinn DK, Master CL. The spectrum of mild traumatic brain injury: A review. Neurology 2017; 89:623-632. [PMID: 28701496 PMCID: PMC5562956 DOI: 10.1212/wnl.0000000000004214] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/24/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This review provides an in-depth overview of diagnostic schema and risk factors influencing recovery during the acute, subacute (operationally defined as up to 3 months postinjury), and chronic injury phases across the full spectrum of individuals (e.g., athletes to neurosurgery patients) with mild traumatic brain injury (mTBI). Particular emphasis is placed on the complex differential diagnoses for patients with prolonged postconcussive symptoms. METHODS Select literature review and synthesis. RESULTS In spite of an increase in public awareness surrounding the acute and potential long-term effects of mTBI, the medical field remains fragmented both in terms of the diagnostic (different criteria proffered by multiple medical organizations) and prognostic factors that influence patient care. CONCLUSIONS Given the lack of objective biomarkers and the spectrum of different disorders that likely encompass mTBI, clinicians are encouraged to adopt a probabilistic, rather than definitive, diagnostic and prognostic framework. The relevance of accurately diagnosing and managing the different manifestations of mTBI becomes clear when one considers the overall incidence of the disorder (42 million people each year worldwide), and the different treatment implications for patients with a true neurodegenerative disorder (e.g., chronic traumatic encephalopathy; rare) vs potentially treatable conditions (e.g., depression or posttraumatic headache; frequent).
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Affiliation(s)
- Andrew R Mayer
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M.); Departments of Neurology (A.R.M.), Psychiatry (A.R.M., D.K.Q.), and Psychology (A.R.M.), University of New Mexico School of Medicine, Albuquerque; Departments of Pediatrics and Surgery (C.L.M.), The Children's Hospital of Philadelphia; and Perelman School of Medicine at the University of Pennsylvania (C.L.M.), Philadelphia.
| | - Davin K Quinn
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M.); Departments of Neurology (A.R.M.), Psychiatry (A.R.M., D.K.Q.), and Psychology (A.R.M.), University of New Mexico School of Medicine, Albuquerque; Departments of Pediatrics and Surgery (C.L.M.), The Children's Hospital of Philadelphia; and Perelman School of Medicine at the University of Pennsylvania (C.L.M.), Philadelphia
| | - Christina L Master
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M.); Departments of Neurology (A.R.M.), Psychiatry (A.R.M., D.K.Q.), and Psychology (A.R.M.), University of New Mexico School of Medicine, Albuquerque; Departments of Pediatrics and Surgery (C.L.M.), The Children's Hospital of Philadelphia; and Perelman School of Medicine at the University of Pennsylvania (C.L.M.), Philadelphia
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Hernandez SHA, Morgan BJ, Hernandez BF, Parshall MB. Building academic-military research collaborations to improve the health of service members. Nurs Outlook 2017; 65:718-725. [PMID: 28601252 DOI: 10.1016/j.outlook.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Academic-military research collaborations are desirable for many reasons; however, little guidance in the literature exists to help researchers understand collaboration requirements. PURPOSE To describe the process for establishing academic-military research collaborations. METHOD Specific collaboration requirements researchers must be aware of are outlined, two case studies are provided, and opportunities for and challenges with collaborations are discussed. DISCUSSION Academic-military collaborations made it possible to conduct studies of stigma and barriers with mental health care among military nursing personnel and the utilization of secure messaging for health concerns with service members and healthcare providers. Planning these efforts began in the earliest stages of developing research proposals, and additional time was required to complete regulatory requirements prior to study implementation. Understanding military-specific considerations and establishing clear expectations and responsibilities were essential. CONCLUSIONS Despite the challenges involved, academic-military collaborations improve the quality of the research by enhancing access to funding, expertise, and resources.
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Affiliation(s)
| | - Brenda J Morgan
- 59(th) Medical Wing Nursing Research Division, Joint Base San Antonio, Lackland, TX
| | | | - Mark B Parshall
- University of New Mexico, College of Nursing, Albuquerque, NM
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Chen H, Desai A, Kim HY. Repetitive Closed-Head Impact Model of Engineered Rotational Acceleration Induces Long-Term Cognitive Impairments with Persistent Astrogliosis and Microgliosis in Mice. J Neurotrauma 2017; 34:2291-2302. [PMID: 28288551 DOI: 10.1089/neu.2016.4870] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Repeated mild traumatic brain injury (rmTBI) has been identified by epidemiology as a high-risk factor for dementia at a later stage in life. Animal models to replicate complex features of human rmTBI and/or to evaluate long-term effects on brain function have not been established. In this study, we used a novel closed-head impact model of engineered rotational acceleration (CHIMERA) to investigate the long-term neuropathological and cognitive functional consequences of rmTBI. Adult C57BL/6 male mice were subjected to CHIMERA for 3 consecutive days 24 h apart. Functional outcomes were assessed by the beam walk and Morris water maze tests. Neuropathology was evaluated by immunostaining of glial fibrillary acidic protein (GFAP), amyloid precursor protein (APP), and ionizing calcium-binding adaptor molecule-1 (Iba-1), and by quantitative reverse transcription polymerase chain reaction (qRT-PCR) or Western blotting of GFAP, Iba-1, and tumor necrosis factor (TNF)-α. Repeated CHIMERA (rCHIMERA) resulted in motor deficits at 3 days, and in learning and memory impairments that were sustained up to 6 months post injury. GFAP and TNF-α gene expression was increased within a week, whereas astrogliosis and microgliosis were induced starting from day 1 up to 6.5 months after rCHIMERA with upregulated GFAP and Iba-1 protein levels. rCHIMERA also induced APP deposition from day 1 to day 7, but this diminished by 1 month. In conclusion, rCHIMERA produces long-lasting cognitive impairments with astrogliosis and microgliosis in mice, suggesting that rCHIMERA can be a useful animal model to study the long-term complications, as well as the cellular and molecular mechanisms, of human rmTBI.
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Affiliation(s)
- Huazhen Chen
- 1 Laboratory of Molecular Signaling, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health , Rockville, Maryland.,2 Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of Health Sciences , Bethesda, Maryland
| | - Abhishek Desai
- 1 Laboratory of Molecular Signaling, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health , Rockville, Maryland
| | - Hee-Yong Kim
- 1 Laboratory of Molecular Signaling, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health , Rockville, Maryland
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