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Smith AM, Grayson BE. A strike to the head: Parallels between the pediatric and adult human and the rodent in traumatic brain injury. J Neurosci Res 2024; 102:e25364. [PMID: 38953607 DOI: 10.1002/jnr.25364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/05/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
Traumatic brain injury (TBI) is a condition that occurs commonly in children from infancy through adolescence and is a global health concern. Pediatric TBI presents with a bimodal age distribution, with very young children (0-4 years) and adolescents (15-19 years) more commonly injured. Because children's brains are still developing, there is increased vulnerability to the effects of head trauma, which results in entirely different patterns of injury than in adults. Pediatric TBI has a profound and lasting impact on a child's development and quality of life, resulting in long-lasting consequences to physical, cognitive, and emotional development. Chronic issues like learning disabilities, behavioral problems, and emotional disturbances can develop. Early intervention and ongoing support are critical for minimizing these long-term deficits. Many animal models of TBI exist, and each varies significantly, displaying different characteristics of clinical TBI. The neurodevelopment differs in the rodent from the human in timing and effect, so TBI outcomes in the juvenile rodent can thus vary from the human child. The current review compares findings from preclinical TBI work in juvenile and adult rodents to clinical TBI research in pediatric and adult humans. We focus on the four brain regions most affected by TBI: the prefrontal cortex, corpus callosum, hippocampus, and hypothalamus. Each has its unique developmental projections and thus is impacted by TBI differently. This review aims to compare the healthy neurodevelopment of these four brain regions in humans to the developmental processes in rodents.
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Affiliation(s)
- Allie M Smith
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Bernadette E Grayson
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Milillo MM, Neumann CS, Maurer JM, Jin C, Commerce E, Reynolds BL, Harenski CL, Kiehl KA. Association Between Traumatic Brain Injury and Psychopathic Traits Among Justice-Involved Adolescents. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01212-x. [PMID: 38922463 DOI: 10.1007/s10802-024-01212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
Traumatic brain injury (TBI) is a global public health problem and is highly prevalent among justice-involved populations. Pediatric TBI is linked with long-term negative outcomes and is correlated with substance use, criminal behavior, psychiatric disorders, and disruptions in neurocognition. These same TBI correlates are evident among youth with psychopathic traits. Given ongoing neurobiological and social development in adolescence, understanding the link between psychopathic traits and TBI in justice-involved youth is critical. A sample of 263 male adolescents were recruited from a maximum-security juvenile justice facility. Using a structural equation modeling (SEM) framework, measurement invariance of psychopathic traits (TBI ±) was tested, and psychopathy scores were accounted for in terms of TBI variables (severity, age of first TBI, total number), participant's age, IQ, substance use, and internalizing psychopathology. There was evidence of strong invariance across TBI status and those with TBI had higher affective and impulsive lifestyle psychopathic traits than adolescents without TBI. The SEM indicated that TBI severity was associated with lower IQ scores, which in turn were associated with increased lifestyle/antisocial (Factor 2) psychopathic traits. Total number of TBIs was associated with higher substance use, which was associated with both increased interpersonal/affective (Factor 1) and Factor 2 psychopathic traits. These TBI variables also had indirect associations with psychopathic traits through IQ and substance use. The findings indicate that TBI is associated with psychopathic traits and suggest that disturbances in cognition and substance use may be treatment targets for youth with TBI and psychopathic traits.
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Affiliation(s)
- Michaela M Milillo
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA.
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87106, USA.
| | - Craig S Neumann
- Department of Psychology, University of North Texas, Denton, TX, 76201, USA
| | - J Michael Maurer
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Christine Jin
- Department of Psychology, University of North Texas, Denton, TX, 76201, USA
| | - Ella Commerce
- Department of Psychology, University of North Texas, Denton, TX, 76201, USA
| | - Brooke L Reynolds
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Carla L Harenski
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Kent A Kiehl
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA.
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87106, USA.
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Dangayach NS, Kreitzer N, Foreman B, Tosto-Mancuso J. Post-Intensive Care Syndrome in Neurocritical Care Patients. Semin Neurol 2024; 44:398-411. [PMID: 38897212 DOI: 10.1055/s-0044-1787011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.
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Affiliation(s)
- Neha S Dangayach
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jenna Tosto-Mancuso
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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Sherer M, Juengst S, Sander AM, Leon-Novelo L, Liu X, Bogaards J, Chua W, Tran K. Mood Tracker: A Randomized Controlled Trial of a Self-Monitoring Intervention for Emotional Distress After Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00161. [PMID: 38833719 DOI: 10.1097/htr.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Persons with traumatic brain injury (TBI) frequently experience emotional distress (ED) manifested in anxiety and depression. However, they may not access mental health services due to external (eg, access, transportation, and cost) or internal (eg, stigma and discomfort with traditional counseling) barriers. Based on substantial literature indicating that self-monitoring can ameliorate several health conditions, we conducted a randomized, parallel group, wait-list control (WLC) trial of a self-monitoring intervention to decrease ED after TBI. SETTING Community in the southwestern United States. PARTICIPANTS Persons with medically documented complicated mild, moderate, and severe TBI. DESIGN About 127 participants were randomized in blocks of 6 to an active treatment (AT) group, wherein they completed multiple assessments of ED each week over a 6-week period via a smartphone app, or a WLC group in a parallel group, controlled trial. Participants received weekly support calls to promote self-monitoring of ED using ecological momentary assessment. MAIN MEASURES ED (Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7), Satisfaction with Life Scale, and Participation Assessment with Recombined Tools-Objective. RESULTS Analysis of the primary study outcome at 6 weeks after initiation of treatment for the AT group did not demonstrate that self-monitoring was effective in decreasing ED as compared to the WLC group. Brief support calls made weekly to promote compliance with self-monitoring were effective in achieving the target number of self-assessments. About 80% of support calls lasted less than 5 minutes. Greater ED was associated with lower life satisfaction and lower participation indicating the importance of addressing ED in persons with TBI. CONCLUSION Additional work is needed to develop nontraditional interventions to circumvent barriers that prevent persons with TBI from accessing care for ED. Brief support calls may be an effective, low-cost intervention to improve compliance with self-monitoring or self-management interventions.
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Affiliation(s)
- Mark Sherer
- Author Affiliations: Brain Injury Research Center TIRR Memorial Hermann, Houston, Texas (Drs Sherer, Juengst, and Sander and Mss Bogaards, Chua, and Tran); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Drs Sherer and Sander); Department of Physical Medicine and Rehabilitation, McGovern Medical School, UT Health, Houston, Texas (Dr Juengst); and Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas (Dr Leon-Novelo and Ms Liu)
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Ganesh A, Al-Shamli S, Mahadevan S, Chan MF, Burke DT, Al Rasadi K, Al Saadoon M, Al–Adawi S. The Frequency of Neuropsychiatric Sequelae After Traumatic Brain Injury in the Global South: A systematic review and meta-analysis. Sultan Qaboos Univ Med J 2024; 24:161-176. [PMID: 38828247 PMCID: PMC11139369 DOI: 10.18295/squmj.12.2023.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 06/05/2024] Open
Abstract
This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post-TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.
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Affiliation(s)
- Aishwarya Ganesh
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - David T. Burke
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Khalid Al Rasadi
- Medical Research Center, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Muna Al Saadoon
- Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Samir Al–Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Silva RD, Teixeira AC, Pinho JA, Marcos P, Santos JC. Sleep, anxiety, depression, and stress in critically ill patients: a descriptive study in a Portuguese intensive care unit. Acute Crit Care 2024; 39:312-320. [PMID: 38863362 PMCID: PMC11167415 DOI: 10.4266/acc.2023.01256] [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: 09/26/2023] [Revised: 03/02/2024] [Accepted: 04/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Sleep disorders are common among patients admitted to intensive care units (ICUs). This study aimed to assess the perceptions of sleep quality, anxiety, depression, and stress reported by ICU patients and the relationships between these perceptions and patient variables. METHODS This cross-sectional study used consecutive non-probabilistic sampling to select participants. All patients admitted for more than 72 hours of ICU hospitalization at a Portuguese hospital between March and June 2020 were asked to complete the "Richard Campbell Sleep Questionnaire" and "Anxiety, depression, and Stress Assessment Questionnaire." The resulting data were analyzed using descriptive statistics, Pearson's correlation coefficient, Student t-tests for independent samples, and analysis of variance. The significance level for rejecting the null hypothesis was set to α ≤0.05. RESULTS A total of 52 patients admitted to the ICU for at least 72 hours was recruited. The mean age of the participants was 64 years (standard deviation, 14.6); 32 (61.5%) of the participants were male. Approximately 19% had psychiatric disorders. The prevalence of self-reported poor sleep was higher in women (t[50]=2,147, P=0.037) and in participants with psychiatric problems, although this difference was not statistically significant (t[50]=-0.777, P=0.441). Those who reported having sleep disorders before hospitalization had a worse perception of their sleep. CONCLUSIONS Sleep quality perception was worse in female ICU patients, those with psychiatric disorders, and those with sleep alterations before hospitalization. Implementing early interventions and designing nonpharmacological techniques to improve sleep quality of ICU patients is essential.
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Affiliation(s)
- Rui Domingues Silva
- Departamento de Anestesiologia, Cuidados Intensivos e Emergência,Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Abílio Cardoso Teixeira
- Escola Superior de Saúde de Santa Maria, Porto, Portugal
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal
| | - José António Pinho
- Departamento de Anestesiologia, Cuidados Intensivos e Emergência,Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Escola Superior de Saúde de Santa Maria, Porto, Portugal
| | - Pedro Marcos
- Departamento de Anestesiologia, Cuidados Intensivos e Emergência,Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José Carlos Santos
- Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Lisboa, Portugal
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Patlan I, Gamelin G, Khalaj K, Castonguay T, Dover G. Athlete Fear Avoidance, Depression, and Anxiety Are Associated with Acute Concussion Symptoms in Athletes. J Clin Med 2024; 13:2401. [PMID: 38673675 PMCID: PMC11050826 DOI: 10.3390/jcm13082401] [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: 03/01/2024] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Assessing sport-related concussions in athletes presents challenges due to symptom variability. This study aimed to explore the relationship between acute concussion symptoms and athlete fear avoidance, pain catastrophizing, depression, and anxiety. Anxiety and depression have previously been associated with the number of symptoms after a concussion, but no prior research has examined the possible link between athlete fear avoidance and acute concussion symptoms. Methods: Thirty-four collegiate athletes (mean age = 20.9 ± 1.8 years) were assessed within 48 h of a concussion using the Sport Concussion Assessment Tool 5, Athlete Fear Avoidance Questionnaire (AFAQ), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. Results: Results showed a significant association between the athlete fear avoidance and the number of concussion symptoms (r = 0.493, p = 0.003), as well as depression and anxiety measured by HADS (r = 0.686, p < 0.001). Athlete fear avoidance and HADS scores were predictors of symptom severity, explaining 41% of the variance (p = 0.001). Athletes with higher fear avoidance tended to report more symptoms post concussion. Conclusions: This study underscores the link between athlete fear avoidance, anxiety, depression, and the severity of concussion symptoms. Administering the AFAQ to assess athlete fear avoidance at the initial assessment of a concussion may be helpful in interpreting the symptoms of an acute concussion.
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Affiliation(s)
| | | | | | | | - Geoffrey Dover
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (I.P.); (G.G.); (K.K.); (T.C.)
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Liu C, Lu Q, Rao G, Chen X, Liang M, Liu Z. Malingering assessment after severe traumatic brain injury in forensic psychology with a potential embedded symptom validity indicator of Symptom Checklist 90. Front Psychol 2024; 15:1320636. [PMID: 38390415 PMCID: PMC10882088 DOI: 10.3389/fpsyg.2024.1320636] [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: 10/18/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Objective Malingering of neuropsychological damage is common among traumatic brain injury patients pursuing disability compensation in forensic contexts. There is an urgent need to explore differences in neuropsychological assessment outcomes with different levels of cooperation. Methods A total of 420 participants with severe traumatic brain injury were classified into malingering group, partial cooperation group, and complete cooperation group according to the Binomial forced-choice digit memory test. The Wechsler Adult Intelligence Scale, event-related potential component, and Symptom Checklist 90 were applied subsequently to assess the psychological status of participants. Results Participants in the malingering group presented lower scores in the binomial forced-choice digit memory test and the Wechsler Adult Intelligence Scale, lower P3 amplitude, and simultaneously higher scores in the Symptom Checklist 90 than the other two groups. The actual intelligence quotient of participants with malingering tendencies ranged mostly between normal and marginal damage, and they often reported elevated whole scale scores in the Symptom Checklist 90. The Cooperation Index (defined as the ratio of positive symptom distress index to global severity index, CI) was proposed and validated to function as an embedded validity indicator of the Symptom Checklist 90, and the area under the receiver operating characteristic (ROC) curve was 0.938. When valued at 1.28, CI has the highest classification ability in differentiating malingering from non-malingering. Combined with the CI and P3 amplitude, the area under the ROC curve for malingering diagnosis further reached 0.952. Conclusion Any non-optimal effort in a forensic context will lead to unexpected deviation in psychology evaluation results. CI is a potential candidate to act as an embedded validity indicator of the Symptom Checklist 90. The combination of CI and P3 amplitude can help to identify malingering in participants after severe traumatic brain injury.
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Affiliation(s)
- Cong Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuying Lu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Forensic Medicine, Shaoxing University Forensic Center, Shaoxing, China
| | - Guangxun Rao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaorui Chen
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zilong Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Cai LT, Brett BL, Palacios EM, Yuh EL, Bourla I, Wren-Jarvis J, Wang Y, Mac Donald C, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Levin HS, Robertson CS, Temkin N, Markowitz AJ, Manley GT, Stein MB, McCrea MA, Zafonte RD, Nelson LD, Mukherjee P. Emotional Resilience Predicts Preserved White Matter Microstructure Following Mild Traumatic Brain Injury. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:164-175. [PMID: 36152948 PMCID: PMC10065831 DOI: 10.1016/j.bpsc.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adult patients with mild traumatic brain injury (mTBI) exhibit distinct phenotypes of emotional and cognitive functioning identified by latent profile analysis of clinical neuropsychological assessments. When discerned early after injury, these latent clinical profiles have been found to improve prediction of long-term outcomes from mTBI. The present study hypothesized that white matter (WM) microstructure is better preserved in an emotionally resilient mTBI phenotype compared with a neuropsychiatrically distressed mTBI phenotype. METHODS The present study used diffusion magnetic resonance imaging to investigate and compare WM microstructure in major association, projection, and commissural tracts between the two phenotypes and over time. Diffusion magnetic resonance images from 172 patients with mTBI were analyzed to compute individual diffusion tensor imaging maps at 2 weeks and 6 months after injury. RESULTS By comparing the diffusion tensor imaging parameters between the two phenotypes at global, regional, and voxel levels, emotionally resilient patients were shown to have higher axial diffusivity compared with neuropsychiatrically distressed patients early after mTBI. Longitudinal analysis revealed greater compromise of WM microstructure in neuropsychiatrically distressed patients, with greater decrease of global axial diffusivity and more widespread decrease of regional axial diffusivity during the first 6 months after injury compared with emotionally resilient patients. CONCLUSIONS These results provide neuroimaging evidence of WM microstructural differences underpinning mTBI phenotypes identified from neuropsychological assessments and show differing longitudinal trajectories of these biological effects. These findings suggest that diffusion magnetic resonance imaging can provide short- and long-term imaging biomarkers of resilience.
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Affiliation(s)
- Lanya T Cai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eva M Palacios
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christine Mac Donald
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Ramon Diaz-Arrastia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Harvey S Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Amy J Markowitz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Geoffrey T Manley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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de Souza NL, Kumar RG, Pruyser A, Blunt EE, Sanders W, Meydan A, Lawrence P, Venkatesan UM, Mac Donald CL, Hoffman JM, Bodien YG, Edlow BL, Dams-O'Connor K. Intimate Partner Violence and Other Trauma Exposures in Females With Traumatic Brain Injury. J Neurotrauma 2024; 41:529-536. [PMID: 37974411 PMCID: PMC10837032 DOI: 10.1089/neu.2023.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
We examined whether females with a history of traumatic brain injury (TBI) and intimate partner violence (IPV) have greater exposure to lifetime trauma relative to females with TBI but no IPV history. Further, we assessed the effects of lifetime trauma on psychological outcomes after TBI. Female participants (n = 70; age M [standard deviation-SD] = 50.5 [15.2] years) with TBI (time since injury median [interquartile range -IQR] = 10.2 [5.3-17.8] years) completed a structured assessment of lifetime history of TBI, including an IPV module to query head injuries from physical violence by an intimate partner. We characterized lifetime trauma exposure with the Adverse Childhood Experiences (ACEs) questionnaire and Survey of Exposure to Community Violence (CV). We evaluated psychological functioning with self-report questionnaires of post-traumatic stress disorder (PTSD), depression, and anxiety symptoms. Compared with those with no IPV history (n = 51), participants reporting IPV-related head injuries (n = 19; 27.1%) reported more ACEs (M[SD] IPV: 4.5[2.9]; No IPV: 1.6[1.8], p < 0.001, d = 1.08) and greater CV (IPV: 17.5[8.4]; No IPV: 7.6[6.1], p < .0001, d = 1.26). Within the full sample, ACEs (β = 0.21, 95% confidence interval [CI] = 0.04-0.39) and CV (β = 0.07, 95% CI = 0.01-0.13) predicted worse PTSD symptoms, while IPV alone did not. Exposure to all three sources of trauma (ACEs, CV, and IPV) was associated with worse PTSD symptoms relative to fewer traumas. The results highlight the scope of traumatic exposures among TBI survivors and the importance of considering IPV and other lifetime trauma exposure in assessing and managing TBI. Trauma-informed interventions that are modified for TBI-related impairment may offer improved outcomes in managing psychological symptoms.
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Affiliation(s)
- Nicola L. de Souza
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj G. Kumar
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ariel Pruyser
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily E. Blunt
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Sanders
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Anogue Meydan
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Phoebe Lawrence
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Umesh M. Venkatesan
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA
| | - Christine L. Mac Donald
- Department of Neurological Surgery and University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Carmichael J, Ponsford J, Gould KR, Spitz G. Characterizing depression after traumatic brain injury using a symptom-oriented approach. J Affect Disord 2024; 345:455-466. [PMID: 37879410 DOI: 10.1016/j.jad.2023.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Progress in addressing depression after traumatic brain injury (TBI) has been limited. Traditional approaches to measuring depression classify individuals with diverse symptoms as having the same problem. We adopted a novel, symptom-oriented approach to characterize post-TBI depression, emphasizing specific symptoms rather than the number of symptoms. METHODS We assessed depressive symptoms cross-sectionally in 393 participants with moderate-severe TBI (range 0.4-35.4 years post-injury; M = 12.6) using the Inventory of Depression and Anxiety Symptoms - Expanded Version (IDAS-II). We analyzed symptoms of DSM-5 major depressive disorder (MDD), separating compound symptoms into sub-symptoms. We quantified depression heterogeneity across 16 specific symptoms and explored associations between each symptom and personal, injury-related, treatment, and functional/psychosocial outcome factors. RESULTS 28 % of participants self-reported a current depression diagnosis, and 35 % met DSM-5 symptom criteria for MDD. Depressed participants (according to either self-reported diagnosis or MDD symptom criteria) were more likely to endorse each specific depressive symptom, including those that overlap with TBI. Post-TBI depression was highly heterogeneous, with 84-91 % of depressed participants (depending on classification method) showing a unique symptom profile not shared with any other individual. The most common symptom profile was shared by only three individuals. This heterogeneity was meaningful, as specific depressive symptoms had distinct associations with personal, injury-related, treatment, and outcome factors. LIMITATIONS Cross-sectional design. We only analyzed DSM-5 MDD symptoms, and some symptoms were assessed using only one item. CONCLUSIONS A symptom-oriented approach to post-TBI depression captures the individual's unique profile of depressive symptoms, which relate differently to outcomes and other factors. We recommend future studies investigating post-TBI depression analyze specific symptoms alongside overall depression scores.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia; Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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12
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Ketchum JM, Hoffman JM, Agtarap S, Hammond FM, Martin AM, Walker WC, Zafonte R, Harrison-Felix C, Nakase-Richardson R. Relationship Between Extreme Pain Phenotypes and Psychosocial Outcomes in Persons With Chronic Pain Following Traumatic Brain Injury: A NIDILRR and VA TBI Model Systems Collaborative Project. J Head Trauma Rehabil 2024; 39:56-67. [PMID: 38032831 PMCID: PMC10842936 DOI: 10.1097/htr.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To examine the relationship between extreme pain phenotypes (interference and improvement) and psychosocial outcomes among those with chronic pain after traumatic brain injury (TBI). SETTING Community. PARTICIPANTS In total, 1762 TBI Model Systems (TBIMS) participants 1 to 30 years postinjury reporting chronic pain. DESIGN Multisite, cross-sectional, observational cohort study. PRIMARY MEASURES Life satisfaction, posttraumatic stress, depression and anxiety symptoms, sleep and participation, the Brief Pain Inventory (BPI) interference scale, and the Patient's Global Impression of Change (PGIC). RESULTS Persons in the extreme high interference phenotype (vs extreme low interference phenotype) and/or extreme no change phenotype (vs extreme improvement phenotype) had poorer psychosocial outcomes, with extreme pain interference phenotypes having a larger effect on outcomes than extreme perceived improvement phenotypes. After controlling for covariates, large effect sizes (ES) related to pain interference were observed for posttraumatic stress symptoms (ES = -1.14), sleep quality (ES = -1.10), depression (ES = -1.08), anxiety (ES = -0.82), and life satisfaction (ES = 0.76); effect sizes for participation outcomes, although significant, were relatively small (ES = 0.21-0.36). Effect sizes related to perceived improvement were small for life satisfaction (ES = 0.20) and participation (ES = 0.16-0.21) outcomes. Pain intensity was identified as a meaningful confounding factor of the relationships between extreme phenotypes and posttraumatic stress, depression, anxiety, and sleep quality. CONCLUSIONS Examination of extreme phenotypes provides important insights into the experience of individuals living with chronic pain and TBI. Results suggest that the relationships among a variety of characteristics of the person, their experience with pain, and treatment of pain are complex. Further research is needed to better understand these complex relationships and how differences in pain interference and perceived improvement from treatment can assist in assessment and treatment of chronic pain after TBI.
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Affiliation(s)
- Jessica M Ketchum
- Craig Hospital Research Department, Englewood, Colorado (Drs Ketchum, Agtarap, and Harrison-Felix); Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine & Rehabilitation, Hospital of Indiana, Indianapolis (Dr Hammond); Mental Health and Behavioral Science Service (Dr Martin) and MHBS/Polytrauma (Dr Nakase-Richardson), James A. Haley Veterans Hospital, VA Tampa Health Care, Tampa, Florida; Department of Psychiatry and Behavioral Neurosciences (Dr Martin) and Sleep and Pulmonary Division, Department of Internal Medicine (Dr Nakase-Richardson), University of South Florida, Tampa; Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond (Dr Walker); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, and Harvard Medical School, Boston, Massachusetts (Dr Zafonte); and Defense Health Agency Traumatic Brain Injury Center of Excellence, Tampa, Florida (Dr Nakase-Richardson)
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13
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Desdentado L, Miragall M, Llorens R, Navarro MD, Baños RM. Identifying and regulating emotions after acquired brain injury: the role of interoceptive sensibility. Front Psychol 2023; 14:1268926. [PMID: 38179500 PMCID: PMC10764614 DOI: 10.3389/fpsyg.2023.1268926] [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: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Interoceptive deficits are associated with difficulties in identifying and regulating emotions. However, research on interoception after acquired brain injury (ABI) is scarce, and its relationship with emotional difficulties in this population is unknown. This study aimed to (1) examine differences in self-reported alexithymia, performance-based emotional awareness, emotion regulation, depression, and interoceptive sensibility between ABI and control individuals; and (2) analyze the role of adaptive interoceptive dimensions in these emotional processes after ABI. Methods Forty-three individuals with ABI and 42 matched control individuals completed the Multidimensional Assessment of Interoceptive Awareness-2, the Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Difficulties in Emotion Regulation Scale, and the Hospital Anxiety and Depression Scale. Results Compared to the control group, individuals with ABI showed reduced tendency to ignore unpleasant sensations increased severity of depressive symptoms, as well as tendencies to have greater difficulties in emotion regulation and lower emotional awareness. Additionally, interoceptive dimensions such as trusting, as well as not-distracting from and not-worrying about bodily sensations, played a relevant role in explaining lower alexithymia and difficulties in emotion regulation. Moreover, lower alexithymia and emotion dysregulation were related to less depressive symptoms. These relationships were invariant across ABI and control individuals. Discussion Although individuals with ABI may have different levels of emotional abilities compared to non-ABI individuals, the relationship patterns between interoceptive and emotional processes appear to be similar between the two groups. This study suggests the potential benefit of addressing both interoceptive and emotional difficulties in treatments targeting such prevalent sequelae of ABI as depressive symptoms.
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Affiliation(s)
- Lorena Desdentado
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Marta Miragall
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Institute for Human-Centered Technology Research, Universitat Politècnica de València, Valencia, Spain
| | | | - Rosa M. Baños
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
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14
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Fynn DM, Preece DA, Gignac GE, Pestell CF, Weinborn M, Becerra R. Alexithymia as a risk factor for poor emotional outcomes in adults with acquired brain injury. Neuropsychol Rehabil 2023; 33:1650-1671. [PMID: 37988367 DOI: 10.1080/09602011.2022.2140680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Emotional disorders are pervasive in the acquired brain injury (ABI) population, adversely affecting quality of life and rehabilitation. This study aimed to explore the unique associative effects of alexithymia as measured by the Perth Alexithymia Questionnaire (PAQ; i.e., difficulty identifying positive/negative feelings, difficulty describing positive/negative feelings, and externally orientated thinking), on emotional outcomes as measured by the Depression Anxiety Stress Scale-21 (DASS-21) and Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment index, in 83 adults with ABI. The addition of alexithymia to hierarchical multiple regression models (controlling for demographic, injury-related, and functional outcome variables) yielded statistically significant changes in R2 for all emotional outcome measures (i.e., Depression, Anxiety, Stress, and Adjustment). Difficulty identifying negative feelings was found to be a significant unique predictor of Depression (β = .43 p = <.001), Anxiety (β = .40, p <.001), Stress (β = .49, p <.001), and Adjustment (β = .26, p = .001). Externally oriented thinking was found to be a significant unique predictor of Adjustment (β = -.15, p = .033). These findings strengthen the argument that alexithymia, especially difficulties identifying negative feelings, may be an important risk factor for psychological distress in ABI and should be considered during early rehabilitation.
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Affiliation(s)
- Danielle M Fynn
- School of Psychological Science, The university of Western Australia, Perth, Australia
| | - David A Preece
- School of Psychological Science, The university of Western Australia, Perth, Australia
- School of Population Health and Curtin enAble Institute, Curtin University, Perth, Australia
| | - Gilles E Gignac
- School of Psychological Science, The university of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The university of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, The university of Western Australia, Perth, Australia
| | - Rodrigo Becerra
- School of Psychological Science, The university of Western Australia, Perth, Australia
- Telethon Kids Institute, Perth, Australia
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15
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Heath LM, Kidwai MR, Colella B, Monette G, Tselichtchev P, Tomaszczyk JC, Green RE. Predictors and Functional Outcomes Associated With Longitudinal Trajectories of Anxiety and Depression from 2 to ≥36 Months After Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:2311-2320. [PMID: 36927109 DOI: 10.1089/neu.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
This study investigated longitudinal trajectories of anxiety and depressive symptoms following moderate-severe traumatic brain injury (TBI), predictors of the trajectories, and associations with 1-year return to productivity. One hundred forty-eight patients with moderate-severe TBI were assessed at 2, 5, 12, and ≥36 months post-injury on the Beck Anxiety Inventory and the Beck Depression Inventory. Clinical interviews obtained information about demographics, injury characteristics, and 1-year return to productivity. Latent growth mixture modeling identified trajectories of anxiety and depression across time. The three-step method identified predictors of trajectories, and χ2 analyses determined associations between trajectories and 1-year return to productivity. Analyses revealed that four-class models of anxiety and depression best fit the data. Most individuals had stable minimal (67%) or low (18%) levels of anxiety over time. Two other subsets of individuals were classified by anxiety that worsened rapidly (7%) or improved in the 1st year but worsened by 3 years post-injury (9%). Similarly for the depression trajectories, most individuals had stable minimal (70%) or low (10%) levels of depression over time. Others had depression that worsened rapidly (12%) or was delayed, with onset 1-year post-injury (8%). Predictors of worsening anxiety and depression included younger age, less education, and male gender. Those with worsening anxiety or depression were less likely to return to productivity by 1-year post-injury. There is a significant burden of anxiety (15%) and depression (20%) in the 3 years after moderate-severe TBI. Future research targeting at-risk patients may help to improve quality of life and functional recovery.
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Affiliation(s)
- Laura M Heath
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - M Rafae Kidwai
- Department of Biology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Brenda Colella
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Georges Monette
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Pavel Tselichtchev
- Rehabilitation Sciences Institute, and University of Toronto, Toronto, Ontario, Canada
| | - Jennifer C Tomaszczyk
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Robin E Green
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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16
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Chiou KS, Rajaram SS, Garlinghouse M, Reisher P. Differences in Symptom Report by Survivors With and Without Probable Intimate Partner Violence-Related Brain Injury. Violence Against Women 2023; 29:2812-2823. [PMID: 37559478 DOI: 10.1177/10778012231192594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Survivors of intimate partner violence (IPV) are at heightened risk of sustaining a brain injury (BI). Problematically, a high overlap between BI and trauma symptoms leads to difficulties in identifying when an IPV-related BI has occurred. This paper investigated differences in symptom reports between survivors with (n = 95) and without (n = 42) probable IPV-related BI. Chi-squared analyses isolated a constellation of symptoms found to be specifically associated with BI status. These symptomatic markers may assist professionals in discerning BI from other comorbid conditions present in IPV, and thus help survivors access BI-specific treatments and resources.
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Affiliation(s)
- Kathy S Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Shireen S Rajaram
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew Garlinghouse
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
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17
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Wender CLA, Ray LN, Sandroff BM, Krch D. Exercise as a behavioral approach to improve mood in persons with traumatic brain injury. PM R 2023. [PMID: 37874561 DOI: 10.1002/pmrj.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/12/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
Mood disturbance is a common, long-term, negative consequence of traumatic brain injury (TBI) that is insufficiently addressed by most traditional treatment modalities. A large body of evidence supports the efficacy of exercise training (ET) to broadly improve mood, as measured most often by the Profile of Mood States (POMS). However, this behavioral approach is not used nearly enough in the TBI population, and when it is, mood is rarely measured. This scoping review will evaluate the use of POMS as a mood measure in TBI research and to establish a rationale for using ET as a behavioral approach to broadly improve mood in persons with TBI.
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Affiliation(s)
- Carly L A Wender
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - LaShawnna N Ray
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Brian M Sandroff
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
- Center for Neuropsychology & Neuroscience Research, Kessler Foundation, West Orange, New Jersey, USA
| | - Denise Krch
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
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18
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Monsour M, Lee JY, Borlongan CV. An Understated Comorbidity: The Impact of Homelessness on Traumatic Brain Injury. Neurotherapeutics 2023; 20:1446-1456. [PMID: 37639189 PMCID: PMC10684446 DOI: 10.1007/s13311-023-01419-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Traumatic brain injury (TBI), a neurovascular injury caused by external force, is a common diagnosis among veterans and those experiencing homelessness (HL). There is a significant overlap in the veteran and homeless population, possibly accounting for the two to seven times greater incidence of TBI among those experiencing HL than the general population. Despite these statistics, individuals experiencing HL are often underdiagnosed and ineffectively treated for TBI. We introduced a novel model of HL. Over 5 weeks, adult Sprague-Dawley rats were randomly assigned to one of the following conditions: TBI only, HL only, TBI + HL, or control (n = 9 per group). To emulate HL, animals (2 animals per cage) were exposed to soiled beddings for 5 weeks. Subsequently, animals were introduced to TBI by using the moderate controlled cortical impact model, then underwent 4 consecutive days of behavioral testing (beam walk (BW), elevated body swing test (EBST), forelimb akinesia (FA), paw grasp (PG), Rotorod, and elevated T-maze). Nissl staining was performed to determine the peri-impact cell survival and the integrity of corpus callosum area. Motor function was significantly impaired by TBI, regardless of housing (beam walk or BW 85.0%, forelimb akinesia or FA 104.7%, and paw grasp or PG 100% greater deficit compared to control). Deficits were worsened by HL in TBI rats (BW 93.3%, FA 40.5%, and PG 50% greater deficit). Two-way ANOVA revealed BW (F(4, 160) = 31.69, p < 0.0001), FA (F(4, 160) = 13.71, p < 0.0001), PG (F(4, 160) = 3.873, p = 0.005), Rotorod (F(4, 160), p = 1.116), and EBST (F(4, 160) = 6.929, p < 0.0001) showed significant differences between groups. The Rotorod and EBST tests showed TBI-induced functional deficits when analyzed by day, but these deficits were not exacerbated by HL. TBI only and TBI + HL rats exhibited typical cortical impact damage (F(3,95) = 51.75, p < 0.0001) and peri-impact cell loss compared to control group (F(3,238) = 47.34, p < 0.0001). Most notably, TBI + HL rats showed significant alterations in WM area measured via the corpus callosum (F(3, 95) = 3.764, p = 0.0133). Worsened behavioral outcomes displayed by TBI + HL rats compared to TBI alone suggest HL contributes to TBI functional deficits. While an intact white matter, such as the corpus callosum, may lessen the consequent functional deficits associated with TBI by enhancing hemispheric communications, there are likely alternative cellular and molecular pathways mitigating TBI-associated inflammatory or oxidative stress responses. Here, we showed that the environmental condition of the patient, i.e., HL, participates in white matter integrity and behavioral outcomes, suggesting its key role in the disease diagnosis to aptly treat TBI patients.
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Affiliation(s)
- M Monsour
- University of South Florida Morsani College of Medicine, 560 Channelside Dr., Tampa, FL, 33606, USA
| | - J-Y Lee
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - C V Borlongan
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
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19
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Samiotis A, Hicks AJ, Ponsford J, Spitz G. Transdiagnostic MRI markers of psychopathology following traumatic brain injury: a systematic review and network meta-analysis protocol. BMJ Open 2023; 13:e072075. [PMID: 37730404 PMCID: PMC10510890 DOI: 10.1136/bmjopen-2023-072075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Psychopathology following traumatic brain injury (TBI) is a common and debilitating consequence that is often associated with reduced functional and psychosocial outcomes. There is a lack of evidence regarding the neural underpinnings of psychopathology following TBI, and whether there may be transdiagnostic neural markers that are shared across traditional psychiatric diagnoses. The aim of this systematic review and meta-analysis is to examine the association of MRI-derived markers of brain structure and function with both transdiagnostic and specific psychopathology following moderate-severe TBI. METHODS AND ANALYSIS A systematic literature search of Embase (1974-2022), Ovid MEDLINE (1946-2022) and PsycINFO (1806-2022) will be conducted. Publications in English that investigate MRI correlates of psychopathology characterised by formal diagnoses or symptoms of psychopathology in closed moderate-severe TBI populations over 16 years of age will be included. Publications will be excluded that: (a) evaluate non-MRI neuroimaging techniques (CT, positron emission tomography, magnetoencephalography, electroencephalogram); (b) comprise primarily a paediatric cohort; (c) comprise primarily penetrating TBI. Eligible studies will be assessed against a modified Joanna Briggs Institute Critical Appraisal Instrument and data will be extracted by two independent reviewers. A descriptive analysis of MRI findings will be provided based on qualitative synthesis of data extracted. Quantitative analyses will include a meta-analysis and a network meta-analysis where there are sufficient data available. ETHICS AND DISSEMINATION Ethics approval is not required for the present study as there will be no original data collected. We intend to disseminate the results through publication to a high-quality peer-reviewed journal and conference presentations on completion. PROSPERO REGISTRATION NUMBER CRD42022358358.
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Affiliation(s)
- Alexia Samiotis
- Translational Neuroscience, Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Amelia J Hicks
- Translational Neuroscience, Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie Ponsford
- Translational Neuroscience, Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Gershon Spitz
- Translational Neuroscience, Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Penn C, Mayilsamy K, Zhu XX, Bauer MA, Mohapatra SS, Frisina RD, Mohapatra S. A mouse model of repeated traumatic brain injury-induced hearing impairment: Early cochlear neurodegeneration in the absence of hair cell loss. Hear Res 2023; 436:108832. [PMID: 37364367 DOI: 10.1016/j.heares.2023.108832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Traumatic Brain Injury (TBI) is a major cause of death and disability worldwide. Mounting evidence suggests that even mild TBI injuries, which comprise >75% of all TBIs, can cause chronic post-concussive neurological symptoms, especially when experienced repetitively (rTBI). The most common post-concussive symptoms include auditory dysfunction in the form of hearing loss, tinnitus, or impaired auditory processing, which can occur even in the absence of direct damage to the auditory system at the time of injury. The mechanism by which indirect damage causes loss of auditory function is poorly understood, and treatment is currently limited to symptom management rather than preventative care. We reasoned that secondary injury mechanisms, such as inflammation, may lead to damage of the inner ear and parts of the brain used for hearing after rTBI. Herein, we established a model of indirect damage to the auditory system induced by rTBI and characterized the pathology of hearing loss. METHODS We established a mouse model of rTBI in order to determine a timeline of auditory pathology following multiple mild injuries. Mice were subject to controlled cortical impact at the skull midline once every 48 h, for a total of 5 hits. Auditory function was assessed via the auditory brainstem response (ABR) at various timepoints post injury. Brain and cochleae were collected to establish a timeline of cellular pathology. RESULTS We observed increased ABR thresholds and decreased (ABR) P1 amplitudes in rTBI vs sham animals at 14 days post-impact (dpi). This effect persisted for up to 60 days (dpi). Auditory temporal processing was impaired beginning at 30 dpi. Spiral ganglion degeneration was evident at 14 dpi. No loss of hair cells was detected at this time, suggesting that neuronal loss is one of the earliest notable events in hearing loss caused by this type of rTBI. CONCLUSIONS We conclude that rTBI results in chronic auditory dysfunction via damage to the spiral ganglion which occurs in the absence of any reduction in hair cell number. This suggests early neuronal damage that may be caused by systemic mechanisms similar to those leading to the spread of neuronal death in the brain following TBI. This TBI-hearing loss model provides an important first step towards identifying therapeutic targets to attenuate damage to the auditory system following head injury.
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Affiliation(s)
- Courtney Penn
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; James A Haley VA Hospital, Tampa, FL 33612, USA
| | - Karthick Mayilsamy
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; James A Haley VA Hospital, Tampa, FL 33612, USA
| | - Xiao Xia Zhu
- Department of Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Mark A Bauer
- Department of Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Shyam S Mohapatra
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; James A Haley VA Hospital, Tampa, FL 33612, USA
| | - Robert D Frisina
- Department of Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.
| | - Subhra Mohapatra
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; James A Haley VA Hospital, Tampa, FL 33612, USA.
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21
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Li LM, Carson A, Dams-O'Connor K. Psychiatric sequelae of traumatic brain injury - future directions in research. Nat Rev Neurol 2023; 19:556-571. [PMID: 37591931 DOI: 10.1038/s41582-023-00853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person's sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.
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Affiliation(s)
- Lucia M Li
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Zhao Y, Ning YL, Zhou YG. A 2AR and traumatic brain injury. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 170:225-265. [PMID: 37741693 DOI: 10.1016/bs.irn.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Accumulating evidence has revealed the adenosine 2A receptor is a key tuner for neuropathological and neurobehavioral changes following traumatic brain injury by experimental animal models and a few clinical trials. Here, we highlight recent data involving acute/sub-acute and chronic alterations of adenosine and adenosine 2A receptor-associated signaling in pathological conditions after trauma, with an emphasis of traumatic brain injury, including neuroinflammation, cognitive and psychiatric disorders, and other severe consequences. We expect this would lead to the development of therapeutic strategies for trauma-related disorders with novel mechanisms of action.
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Affiliation(s)
- Yan Zhao
- Department of Army Occupational Disease, State Key Laboratory of Trauma and Chemical Poisoning, Research Institute of Surgery and Daping Hospital, Army Medical University, P.R. China; Institute of Brain and Intelligence, Army Medical University, Chongqing, P.R. China
| | - Ya-Lei Ning
- Department of Army Occupational Disease, State Key Laboratory of Trauma and Chemical Poisoning, Research Institute of Surgery and Daping Hospital, Army Medical University, P.R. China; Institute of Brain and Intelligence, Army Medical University, Chongqing, P.R. China
| | - Yuan-Guo Zhou
- Department of Army Occupational Disease, State Key Laboratory of Trauma and Chemical Poisoning, Research Institute of Surgery and Daping Hospital, Army Medical University, P.R. China; Institute of Brain and Intelligence, Army Medical University, Chongqing, P.R. China.
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23
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Anderson C, Hicks AJ, Carmichael J, Burke R, Ponsford J. COMT Val158Met and BDNF Val66Met Single-Nucleotide Polymorphisms Are Not Associated With Emotional Distress One Year After Moderate-Severe Traumatic Brain Injury. Neurotrauma Rep 2023; 4:495-506. [PMID: 37636335 PMCID: PMC10457651 DOI: 10.1089/neur.2023.0028] [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] [Indexed: 08/29/2023] Open
Abstract
Emotional distress is a common, but poorly addressed, feature of moderate-severe traumatic brain injury (TBI). Previously identified sociodemographic, psychological, and injury-related factors account for only a small proportion of the variability in emotional distress post-TBI. Genetic factors may help to further understand emotional distress in this population. The catechol-O-methyltransferase (COMT) Val158 and brain-derived neurotrophic factor (BDNF) 66Met single-nucleotide polymorphisms (SNPs) have been identified as possible contributory factors to outcomes after TBI. We investigated whether the COMT Val158 and BDNF 66Met SNPs were associated with emotional distress 1 year after moderate-severe TBI, and whether these associations were moderated by age, sex, and TBI severity (as measured by the duration of post-traumatic amnesia [PTA]). Moderate-severe TBI survivors (COMT, n = 391; BDNF, n = 311) provided saliva samples after admission to a TBI rehabilitation hospital. At a follow-up interview ∼1 year after injury, participants completed a self-report measure of emotional distress (Hospital Anxiety and Depression Scale; HADS). Multiple linear regression models were constructed for each SNP to predict total scores on the HADS. Neither COMT Val158 nor BDNF 66Met carriage status (carrier vs. non-carrier) significantly predicted emotional distress (COMT, p = 0.49; BDNF, p = 0.66). Interactions of SNP × age (COMT, p = 0.90; BDNF, p = 0.93), SNP × sex (COMT, p = 0.09; BDNF, p = 0.60), SNP × injury severity (COMT, p = 0.53; BDNF, p = 0.87), and SNP × sex × age (COMT, p = 0.08; BDNF, p = 0.76) were also non-significant. Our null findings suggest that COMT Val158 and BDNF 66Met SNPs do not aid the prediction of emotional distress 1 year after moderate-severe TBI, neither in isolation nor in interaction with age, sex and injury severity. The reporting of null findings such as ours is important to avoid publication bias and prompt researchers to consider the challenges of single-gene candidate studies in understanding post-TBI outcomes. Analyses in larger samples that incorporate multiple genetic factors and their relevant moderating factors may provide a greater understanding of the role of genetics in post-TBI emotional distress.
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Affiliation(s)
- Chloe Anderson
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Amelia J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Richard Burke
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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24
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Witten JA, Coetzer R, Rowlands L, Turnbull OH. "Talk and Chalk": An emotion regulation intervention for anger after acquired brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-16. [PMID: 37339498 DOI: 10.1080/23279095.2023.2224481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Uncontrollable anger is a debilitating consequence of acquired brain injury (ABI). This proof-of-concept study investigated the preliminary efficacy of an emotion regulation intervention for managing post-ABI anger. A secondary objective was to determine which participant characteristics were related to intervention gains. With a pre-post intervention design and three-month follow-up, there were five individually administered meetings on Zoom, over a four-month period. 24 adults who had sustained an ABI were enrolled. Participants were mostly males, from 24 to 85 years old. A series of one-way repeated-measures ANOVAs were conducted to determine the intervention's efficacy, and Spearman's rho bivariate correlations for the association between participant characteristics and intervention gains. Significant differences were observed in external anger from baseline to post-treatment; there were no further changes from post-treatment to follow-up. Of the participant characteristics, only readiness to change and anxiety were correlated. The proposed intervention presents a brief, feasible, and preliminary efficacious alternative for regulating post-ABI anger. Intervention gains are associated with readiness to change and anxiety, which has important implications for clinical delivery.
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Affiliation(s)
| | - Rudi Coetzer
- Department of Psychology, Bangor University, Bangor, United Kingdom
- The Disabilities Trust, Wakefield, United Kingdom
- Faculty of Medical, Life and Health Science, Swansea University, Swansea, United Kingdom
| | - Leanne Rowlands
- School of Psychology, Arden University, Coventry, United Kingdom
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25
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Bockhop F, Cunitz K, Zeldovich M, Buchheim A, Beissbarth T, Hagmayer Y, von Steinbuechel N. Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Traumatic Stress, Anxiety, and Depression after Traumatic Brain Injury. J Clin Med 2023; 12:3873. [PMID: 37373567 DOI: 10.3390/jcm12123873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Psychopathological symptoms are common sequelae after traumatic brain injury (TBI), leading to increased personal and societal burden. Previous studies on factors influencing Post-traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD), and Major Depressive Disorder (MDD) after TBI have produced inconclusive results, partly due to methodological limitations. The current study investigated the influence of commonly proposed factors on the clinical impairment, occurrence, frequency, and intensity of symptoms of PTSD, GAD, and MDD after TBI. The study sample comprised 2069 individuals (65% males). Associations between psychopathological outcomes and sociodemographic, premorbid, and injury-related factors were analyzed using logistic regression, standard, and zero-inflated negative binomial models. Overall, individuals experienced moderate levels of PTSD, GAD, and MDD. Outcomes correlated with early psychiatric assessments across domains. The clinical impairment, occurrence, frequency, and intensity of all outcomes were associated with the educational level, premorbid psychiatric history, injury cause, and functional recovery. Distinct associations were found for injury severity, LOC, and clinical care pathways with PTSD; age and LOC:sex with GAD; and living situation with MDD, respectively. The use of suitable statistical models supported the identification of factors associated with the multifactorial etiology of psychopathology after TBI. Future research may apply these models to reduce personal and societal burden.
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Affiliation(s)
- Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Katrin Cunitz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Anna Buchheim
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Tim Beissbarth
- Department of Medical Bioinformatics, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - York Hagmayer
- Georg-Elias-Müller Institute for Psychology, Georg-August-University, 37073 Göttingen, Germany
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
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26
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Keatley ES, Bombardier CH, Watson E, Kumar RG, Novack T, Monden KR, Dams-O'Connor K. Cognitive Performance, Depression, and Anxiety 1 Year After Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E195-E202. [PMID: 36730989 PMCID: PMC10102243 DOI: 10.1097/htr.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate associations between depression, anxiety, and cognitive impairment among individuals with complicated mild to severe traumatic brain injury (TBI) 1 year after injury. SETTING Multiple inpatient rehabilitation units across the United States. PARTICIPANTS A total of 498 adults 16 years and older who completed inpatient rehabilitation for complicated mild to severe TBI. DESIGN Secondary analysis of a prospective, multicenter, cross-sectional observational cohort study. MAIN MEASURES Assessments of depression (Traumatic Brain Injury Quality of Life [TBI-QOL] Depression) and anxiety (TBI-QOL Anxiety) as well as a telephone-based brief screening measure of cognitive functioning (Brief Test of Adult Cognition by Telephone [BTACT]). RESULTS We found an inverse relationship between self-reported depression symptoms and the BTACT Composite score (β = -0.18, P < .01) and anxiety symptoms and the BTACT Composite score (β = -0.20, P < .01). There was no evidence this relationship varied by injury severity. Exploratory analyses showed depression and anxiety were negatively correlated with both BTACT Executive Function factor score and BTACT Memory factor score. CONCLUSIONS Both depression and anxiety have a small but significant negative association with cognitive performance in the context of complicated mild to severe TBI. These findings highlight the importance of considering depression and anxiety when interpreting TBI-related neuropsychological impairments, even among more severe TBI.
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Affiliation(s)
- Eva S Keatley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland (Dr Keatley); Department of Physical Medicine and Rehabilitation, University of Washington, Seattle (Dr Bombardier); Departments of Rehabilitation and Human Performance (Drs Watson, Kumar, and Dams-O'Connor) and Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham (Dr Novack); and Research Department, Craig Hospital, Englewood, Colorado, and Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis (Dr Monden)
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27
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Cappelle T, Neumann CS, Cook AM, Kim E, Harenski CL, Edwards BG, Clarke GJB, Decety J, Kiehl KA. Traumatic Brain Injury and Psychopathic Traits in Justice-Involved Adult Women. J Pers Disord 2023; 37:195-212. [PMID: 37002938 DOI: 10.1521/pedi.2023.37.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Studies have documented associations between traumatic brain injury (TBI) and mental disorders. The relationship between psychopathic personality and TBI remains poorly understood, though both are associated with similar characteristics (e.g., low empathy, aggression, disturbances in social/moral behavior). Yet, it is not clear whether assessment of psychopathic features is influenced by presence versus absence of TBI, and which aspects of TBI may be associated with psychopathic traits. This study examined the psychopathy-TBI association in justice-involved women (N = 341) with structural equation modeling. We tested if measurement invariance of psychopathic traits was evident among those with versus without TBI and which TBI variables (number, severity, age at first TBI) predicted psychopathic features in conjunction with symptoms of psychopathology, IQ, and age. Results provided evidence of measurement invariance, and more women with TBI, compared to those without, met criteria for psychopathy. Younger age of TBI and TBI severity predicted interpersonal-affective psychopathic features.
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Affiliation(s)
- Tessa Cappelle
- Department of Psychology, College of Arts and Sciences, University of New Mexico, Albuquerque, New Mexico
| | - Craig S Neumann
- College of Arts and Sciences, University of North Texas, Denton, Texas
| | | | - Esther Kim
- Department of Psychology, College of Arts and Sciences, University of New Mexico, Albuquerque, New Mexico
- Department of Psychology, University of North Texas, Denton, Texas
| | | | - Bethany G Edwards
- Department of Psychology, College of Arts and Sciences, University of New Mexico, Albuquerque, New Mexico
- Mind Research Network, Albuquerque, New Mexico
| | | | - Jean Decety
- Division of the Social Sciences, University of Chicago, Chicago, Illinois
| | - Kent A Kiehl
- Department of Psychology, College of Arts and Sciences, University of New Mexico, Albuquerque, New Mexico
- Mind Research Network, Albuquerque, New Mexico
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28
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Filippone A, Cucinotta L, Bova V, Lanza M, Casili G, Paterniti I, Campolo M, Cuzzocrea S, Esposito E. Inhibition of LRRK2 Attenuates Depression-Related Symptoms in Mice with Moderate Traumatic Brain Injury. Cells 2023; 12:cells12071040. [PMID: 37048114 PMCID: PMC10093681 DOI: 10.3390/cells12071040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Moderate traumatic brain injury (mTBI) has been associated with emotional dysregulation such as loss of consciousness, post-traumatic amnesia and major depressive disorder. The gene Leucine-rich repeat kinase 2 (LRRK2) is involved in protein synthesis and degradation, apoptosis, inflammation and oxidative stress, processes that trigger mTBI. The aim of this study was to investigate the role of LRRK2 in reducing depression-related symptoms after mTBI and to determine whether inhibition of LRRK2 mediated by PF-06447475 could have antidepressant effects. Moderate traumatic brain injury was induced by controlled cortical impact (CCI) and mice were treated with PF-06447475 at doses of 1, 2.5 and 5 mg/kg once daily for 14 days. We performed histological, immunohistochemical and molecular analyses of brain tissue 24 days after mTBI. Furthermore, the tissue changes found in the hippocampus and amygdala confirmed the depression-like behavior. PF-treatment with 06447475 significantly reduced the histological damage and behavioral disturbances. Thus, this study has shown that mTBI induction promotes the development of depression-like behavioral changes. LRRK2 inhibition showed an antidepressant effect and restored the changes in the copper/glutamate/N-methyl-D-aspartic acid receptor (Cu/NMDAR) system.
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29
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Hu X, Ou Y, Li J, Sun M, Ge Q, Pan Y, Cai Z, Tan R, Wang W, An J, Lu H. Voluntary Exercise to Reduce Anxiety Behaviour in Traumatic Brain Injury Shown to Alleviate Inflammatory Brain Response in Mice. Int J Mol Sci 2023; 24:ijms24076365. [PMID: 37047351 PMCID: PMC10093932 DOI: 10.3390/ijms24076365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
Traumatic brain injury is a leading cause of neuroinflammation and anxiety disorders in young adults. Immune-targeted therapies have garnered attention for the amelioration of TBI-induced anxiety. A previous study has indicated that voluntary exercise intervention following TBI could reduce neuroinflammation. It is essential to determine the effects of voluntary exercise after TBI on anxiety via inhibiting neuroinflammatory response. Mice were randomly divided into four groups (sham, TBI, sham + voluntary wheel running (VWR), and TBI + VWR). One-week VWR was carried out on the 2nd day after trauma. The neurofunction of TBI mice was assessed. Following VWR, anxiety behavior was evaluated, and neuroinflammatory responses in the perilesional cortex were investigated. Results showed that after one week of VWR, neurofunctional recovery was enhanced, while the anxiety behavior of TBI mice was significantly alleviated. The level of pro-inflammatory factors decreased, and the level of anti-inflammatory factors elevated. Activation of nucleotide oligomerization domain-like thermal receptor protein domain associated protein 3 (NLRP3) inflammasome was inhibited significantly. All these alterations were consistent with reduced microglial activation at the perilesional site and positively correlated with the amelioration of anxiety behavior. This suggested that timely rehabilitative exercise could be a useful therapeutic strategy for anxiety resulting from TBI by targeting neuroinflammation.
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Affiliation(s)
- Xiaoxuan Hu
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Department of Human Anatomy & Histoembryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yuhang Ou
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Jiashuo Li
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Meiqi Sun
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Qian Ge
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yongqi Pan
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Zhenlu Cai
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Ruolan Tan
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Department of Human Anatomy & Histoembryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Wenyu Wang
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Jing An
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Correspondence: (J.A.); (H.L.)
| | - Haixia Lu
- Department/Institute of Neurobiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory of Ministry of Education for Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Correspondence: (J.A.); (H.L.)
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30
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Silverberg ND, Mikolić A. Management of Psychological Complications Following Mild Traumatic Brain Injury. Curr Neurol Neurosci Rep 2023; 23:49-58. [PMID: 36763333 DOI: 10.1007/s11910-023-01251-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW It has been clear for decades that psychological factors often contribute to mild traumatic brain injury (mTBI) outcome, but an emerging literature has begun to clarify which specific factors are important, when, for whom, and how they impact recovery. This review aims to summarize the contemporary evidence on psychological determinants of recovery from mTBI and its implications for clinical management. RECENT FINDINGS Comorbid mental health disorders and specific illness beliefs and coping behaviors (e.g., fear avoidance) are associated with worse recovery from mTBI. Proactive assessment and intervention for psychological complications can improve clinical outcomes. Evidence-based treatments for primary mental health disorders are likely also effective for treating mental health disorders after mTBI, and can reduce overall post-concussion symptoms. Broad-spectrum cognitive-behavioral therapy may modestly improve post-concussion symptoms, but tailoring delivery to individual psychological risk factors and/or symptoms may improve its efficacy. Addressing psychological factors in treatments delivered primarily by non-psychologists is a promising and cost-effective approach for enhancing clinical management of mTBI. Recent literature emphasizes a bio-psycho-socio-ecological framework for understanding mTBI recovery and a precision rehabilitation approach to maximize recovery. Integrating psychological principles into rehabilitation and tailoring interventions to specific risk factors may improve clinical management of mTBI.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada.
| | - Ana Mikolić
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada
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31
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Aychman MM, Goldman DL, Kaplan JS. Cannabidiol's neuroprotective properties and potential treatment of traumatic brain injuries. Front Neurol 2023; 14:1087011. [PMID: 36816569 PMCID: PMC9932048 DOI: 10.3389/fneur.2023.1087011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Cannabidiol (CBD) has numerous pharmacological targets that initiate anti-inflammatory, antioxidative, and antiepileptic properties. These neuroprotective benefits have generated interest in CBD's therapeutic potential against the secondary injury cascade from traumatic brain injury (TBI). There are currently no effective broad treatment strategies for combating the damaging mechanisms that follow the primary injury and lead to lasting neurological consequences or death. However, CBD's effects on different neurotransmitter systems, the blood brain barrier, oxidative stress mechanisms, and the inflammatory response provides mechanistic support for CBD's clinical utility in TBI. This review describes the cascades of damage caused by TBI and CBD's neuroprotective mechanisms to counter them. We also present challenges in the clinical treatment of TBI and discuss important future clinical research directions for integrating CBD in treatment protocols. The mechanistic evidence provided by pre-clinical research shows great potential for CBD as a much-needed improvement in the clinical treatment of TBI. Upcoming clinical trials sponsored by major professional sport leagues are the first attempts to test the efficacy of CBD in head injury treatment protocols and highlight the need for further clinical research.
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32
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Anderson C, Carmichael J, Hicks AJ, Burke R, Ponsford J. Interaction between APOE ɛ4 and Age Is Associated with Emotional Distress One Year after Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:326-336. [PMID: 35996348 DOI: 10.1089/neu.2022.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Emotional distress is common following moderate-severe traumatic brain injury (TBI) and is associated with poorer post-injury outcomes. Previously investigated sociodemographic, psychological, and injury-related factors account for only a small proportion of variance in post-TBI emotional distress, highlighting a need to consider other factors such as genetic factors. The apolipoprotein E gene (APOE) has been commonly studied in the TBI literature, with the ɛ4 allele linked to worse neuronal repair and recovery. Few studies have investigated the potential relationship between APOE ɛ4 and emotional distress after moderate-severe TBI, and results have been varied. We examined whether APOE ɛ4 was associated with emotional distress 1 year following moderate-severe TBI, and whether this relationship was moderated by age, sex, and TBI severity (as indexed by the duration of post-traumatic amnesia [PTA]). Moderate-severe TBI survivors provided saliva samples following inpatient admission to a TBI rehabilitation hospital. They completed a self-report measure of emotional distress, the Hospital Anxiety and Depression Scale (HADS), at a follow-up interview ∼1 year post-injury. Complete genetic and follow-up data were available for 441 moderate-severe TBI survivors (mean age = 39.42 years; 75% male). We constructed a linear regression model that included APOE ɛ4 carriage status (carrier vs. non-carrier) and interactions with age, sex, and TBI severity (APOE × age, APOE × sex, APOE × age × sex, and APOE × PTA duration) to predict total score on the HADS, while covarying for the main effects of age, sex, PTA duration, and previous head injury. There was a significant main effect of APOE ɛ4, whereby ɛ4 carriers reported less emotional distress than non-carriers (p = 0.04). However, we also found a significant interaction with age such that APOE ɛ4 carriers reported increasingly greater emotional distress with older age compared with non-carriers (p = 0.01). A sensitivity analysis (n = 306) suggested that the APOE × age interaction, and main effects of age and previous head injury, were not unique to individuals with pre-injury mental health problems (n = 136). However, the main effect of APOE ɛ4 was no longer significant when individuals with pre-injury mental health problems were removed. Our findings highlight the importance of considering moderation of genetic associations, suggesting that APOE ɛ4 may be a risk factor for emotional distress specifically among older survivors of moderate-severe TBI. If these findings can be independently replicated, APOE ɛ4 carriage status, interpreted in the context of age, could be incorporated into risk prediction models of emotional distress after moderate-severe TBI, enhancing targeted early detection and intervention efforts.
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Affiliation(s)
- Chloe Anderson
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Richard Burke
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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de Neeling M, Liessens D, Depreitere B. Relationship between psychosocial and psychiatric risk factors and poor long-term outcome following mild traumatic brain injury: A systematic review. Eur J Neurol 2023; 30:1540-1550. [PMID: 36708085 DOI: 10.1111/ene.15713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Mild traumatic brain injury (mTBI) has an estimated worldwide incidence of >60 million per year, and long-term persistent postconcussion symptoms (PPCS) are increasingly recognized as being predicted by psychosocial variables. Patients at risk for PPCS may be amenable to closer follow-up to treat modifiable symptoms and prevent chronicity. In this regard, similarities seem to exist with psychosocial risk factors for chronicity in other health-related conditions. However, as opposed to other conditions, no screening instruments exist for mTBI. METHODS A systematic search of the literature on psychological and psychiatric predictors of long-term symptoms in mTBI was performed by two independent reviewers using PubMed, Embase, and Web of Science. RESULTS Fifty papers were included in the systematic analysis. Anxiety, depressive symptoms, and emotional distress early after injury predict PPCS burden and functional outcome up to 1 year after injury. In addition, coping styles and preinjury psychiatric disorders and mental health also correlate with PPCS burden and functional outcome. Associations between PPCS and personality and beliefs were reported, but either these effects were small or evidence was limited. CONCLUSIONS Early psychological and psychiatric factors may negatively interact with recovery potential to increase the risk of chronicity of PPCS burden after mTBI. This opens opportunities for research on screening tools and early intervention in patients at risk.
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Affiliation(s)
| | - Dirk Liessens
- Saint Camillus Psychiatric Center, Bierbeek, Belgium
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U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study. J Clin Med 2023; 12:jcm12030867. [PMID: 36769514 PMCID: PMC9917706 DOI: 10.3390/jcm12030867] [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: 11/28/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Previous research has found racial and ethnic disparities in life satisfaction, depression, and anxiety after traumatic brain injury (TBI). However, limited studies have examined differences in these variables between U.S.- and foreign-born individuals with TBI. The purpose of this study was to examine whether differences exist in mental health outcomes between U.S.- and foreign-born individuals with TBI at 1, 2, 5, and 10 years after injury, as well as examine whether demographic and injury-related characteristics account for these differences. METHOD Participants were 8289 individuals with TBI who identified as U.S.-born and 944 who identified as born outside the U.S. in the TBI Model Systems study. Participants completed measures of mental health outcomes at 1, 2, 5, and 10 years after injury. RESULTS Foreign-born individuals with TBI had comparable levels of depression and anxiety trajectories to U.S.-born individuals, yet higher life satisfaction trajectories, even after controlling for demographic and injury-related variables. CONCLUSION Rehabilitation professionals should consider in their clinical work the mechanisms that likely influence mental health outcomes among foreign-born individuals, including family-based values that increase resilience, as well as the possible under-reporting of mental health symptoms along the lines of cultural norms.
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Krenz U, Greving S, Zeldovich M, Haagsma J, Polinder S, von Steinbüchel N. Reference Values of the Quality of Life after Brain Injury (QOLIBRI) from a General Population Sample in Italy. J Clin Med 2023; 12:jcm12020491. [PMID: 36675420 PMCID: PMC9864646 DOI: 10.3390/jcm12020491] [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: 10/21/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Traumatic brain injury (TBI) may affect the lives of the individuals concerned and their relatives negatively in many dimensions. Health-related quality of life (HRQoL) is a comprehensive and complex concept that can assess one's satisfaction with a broad range of areas of life and health. The Quality of Life after Traumatic Brain Injury (QOLIBRI) questionnaire is a TBI-specific measure for HRQoL which is used in research and health services worldwide. When evaluating self-reported HRQoL after TBI, reference values from a general population are helpful to perform clinically relevant evaluations and decisions about the condition of an affected person by comparing the patient scores with reference values. Despite the widespread use of the QOLIBRI, reference values have until now only been available for the Netherlands and the United Kingdom. The aim of this study was to validate the QOLIBRI for the general population in Italy and to provide reference values. An adapted form of the QOLIBRI was administered to 3298 Italians from a healthy general population using an online survey. Their scores were compared with those of 298 individuals post-TBI recruited within the international longitudinal observational cohort CENTER-TBI study in Italian hospitals, who completed the original questionnaire. The psychometric characteristics and the measurement invariance of the QOLIBRI were assessed. A regression analysis was performed to identify predictors relevant for HRQoL in the general population. Reference values were provided using percentiles. Measurement invariance analysis showed that the QOLIBRI captures the same HRQoL constructs in an Italian general population and Italian TBI sample from the observational Center-TBI study. Higher age, higher education and the absence of a chronic health condition were associated with higher QOLIBRI scores, suggesting better HRQoL. Reference values were provided for a general Italian population adjusted for age, sex, education and presence of chronic health conditions. We recommend using these for a better interpretation of the QOLIBRI score in clinical practice and research in Italy.
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Affiliation(s)
- Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
- Correspondence:
| | - Sven Greving
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
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Merrill RM, Ashton MK. Rates of injury according to a single or comorbid mental illness identified in a large employee database. J Occup Health 2023; 65:e12387. [PMID: 36718664 PMCID: PMC9887468 DOI: 10.1002/1348-9585.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To identify associations between specific types of mental illness (occurring alone or in combination with other mental illness) and (specific and all types) of injury. METHODS Analyses involve 21 027 employees aged 18-64 insured by Deseret Mutual Benefit Administrator (DMBA), 2020. Nine classifications of mental illness and 12 classifications of injury are considered. Rate ratios are adjusted for age, sex, and marital status. RESULTS The rate of injuries is 13.6%. A positive association exists between any mental illness and injury (rate ratio [RR] = 1.74, 95% CI 1.62-1.87). The positive association is consistent across all types of injury, except burns. While having a mental illness tends to positively associate with having an injury (vs. none), it more strongly associates with having two or more types of injury (vs. none). Injury rates are significantly greater when comorbid mental illness is involved (vs. one type of mental illness), more so for multiple types of injuries. Specifically, there is a positive association between having a mental illness (vs. none) and a single type of injury (vs. none) (RR = 1.58, 95% CI 1.42-1.75) or two or more types of injuries (vs. none) (RR = 1.94, 95% CI 1.70-2.23). Corresponding estimates where comorbid mental illnesses exist (vs. none) are (RR = 2.07, 95% CI 1.70-2.51) and (RR = 3.32, 95% CI 2.64-4.17), respectively. The most common combinations of mental illness that positively associate with injury tend to involve comorbid mental illness. CONCLUSIONS Several types of mental illness positively associate with injury and are more strongly associated when there is comorbid mental illness.
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Affiliation(s)
- Ray M. Merrill
- Department of Public HealthCollege of Life Sciences, Brigham Young UniversityProvoUtahUSA
| | - McKay K. Ashton
- Department of Public HealthCollege of Life Sciences, Brigham Young UniversityProvoUtahUSA
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Korupolu R, Malik A, Ratcliff C, Robinson-Whelen S, Taylor HB. Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review. Arch Phys Med Rehabil 2022; 103:2410-2428. [PMID: 35760105 DOI: 10.1016/j.apmr.2022.05.020] [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: 09/27/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMNDs). DATA SOURCES PubMed, PsycINFO, Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 2001 and June 2021. STUDY SELECTION Clinical trials published in English evaluating MBIs in adults with the 4 most common UMNDs (multiple sclerosis, brain injury including stroke, spinal cord injury, amyotrophic lateral sclerosis) were included. DATA EXTRACTION Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically. DATA SYNTHESIS A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies. The average ± SD duration of MBIs was 8±2 weeks. On average, 85%±14% of participants completed the MBI, and the retention rate at follow-up was 80%±16%. Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized controlled trials that evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared with controls, with differences greater when compared with passive control than active control participants. None of the studies included in this review studied dose response. CONCLUSIONS Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants, with notable improvements in depression, anxiety, fatigue, and quality of life post intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.
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Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas.
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Chelsea Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas
| | - Susan Robinson-Whelen
- TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Heather B Taylor
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas
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Hoffman AN, Watson S, Chavda N, Lam J, Hovda DA, Giza CC, Fanselow MS. Increased Fear Generalization and Amygdala AMPA Receptor Proteins in Chronic Traumatic Brain Injury. J Neurotrauma 2022; 39:1561-1574. [PMID: 35722903 PMCID: PMC9689770 DOI: 10.1089/neu.2022.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairments and emotional lability are common long-term consequences of traumatic brain injury (TBI). How TBI affects interactions between sensory, cognitive, and emotional systems may reveal mechanisms that underlie chronic mental health comorbidities. Previously, we reported changes in auditory-emotional network activity and enhanced fear learning early after TBI. In the current study, we asked whether TBI has long-term effects on fear learning and responses to novel stimuli. Four weeks following lateral fluid percussion injury (FPI) or sham surgery, adult male rats were fear conditioned to either white noise-shock or tone-shock pairing, or shock-only control and subsequently were tested for freezing to context and to the trained or novel auditory cues in a new context. FPI groups showed greater freezing to their trained auditory cue, indicating long-term TBI enhanced fear. Interestingly, FPI-Noise Shock animals displayed robust fear to the novel, untrained tone compared with Sham-Noise Shock across both experiments. Shock Only groups did not differ in freezing to either auditory stimulus. These findings suggest that TBI precipitates maladaptive associative fear generalization rather than non-associative sensitization. Basolateral amygdala (BLA) α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAr) subunits GluA1 and GluA2 levels were analyzed and the FPI-Noise Shock group had increased GluA1 (but not GluA2) levels that correlated with the level of tone fear generalization. This study illustrates a unique chronic TBI phenotype with both a cognitive impairment and increased fear and possibly altered synaptic transmission in the amygdala long after TBI, where stimulus generalization may underlie maladaptive fear and hyperarousal.
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Affiliation(s)
- Ann N. Hoffman
- Department of Neurosurgery, Brain Injury Research Center, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
- Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, California, USA
- Staglin Center for Brain and Behavioral Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Sonya Watson
- Department of Neurosurgery, Brain Injury Research Center, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Nishtha Chavda
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Jamie Lam
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - David A. Hovda
- Department of Neurosurgery, Brain Injury Research Center, University of California, Los Angeles, Los Angeles, California, USA
- Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, California, USA
- Department of Medical and Molecular Pharmacology, University of California, Los Angeles, Los Angeles, California, USA
| | - Christopher C. Giza
- Department of Neurosurgery, Brain Injury Research Center, University of California, Los Angeles, Los Angeles, California, USA
- Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, California, USA
- Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
| | - Michael S. Fanselow
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Staglin Center for Brain and Behavioral Health, University of California, Los Angeles, Los Angeles, California, USA
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Raya-Ruiz MA, Rodríguez-Bailón M, Castaño-Monsalve B, Vidaña-Moya L, Fernández-Solano AJ, Merchán-Baeza JA. Study protocol for a non-randomised controlled trial: Community-based occupational therapy intervention on mental health for people with acquired brain injury (COT-MHABI). PLoS One 2022; 17:e0274193. [PMID: 36206208 PMCID: PMC9543977 DOI: 10.1371/journal.pone.0274193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The sequelae of moderate-severe acquired brain injury (ABI) encompass motor, cognitive, sensory, emotional and behavioural areas that affect meaningful occupational participation and quality of life, with a high prevalence of associated mental disorders. When the patient returns to community life after discharge from the hospital, specialised care is generally insufficient due to the lack of consideration of the dual condition of mental disorder and ABI. Since there is a negative impact on competence and thus on occupational participation, occupational therapy represents a convenient way of intervention. On these assumptions, a community-based occupational therapy protocol on mental health for people with moderate/severe acquired brain injury (COT-MHABI) is presented. It is focused on meaningful occupational participation and looks for improvement in the quality of life. METHODS AND ANALYSIS This study aims: (i) to design a protocol to evaluate the effectiveness of a community occupational therapy intervention based on MOHO for patients with a dual (mental health/ABI) for improving quality of life and self-perceived occupational performance; (ii) to analyse the outcomes of occupational and social variables (occupational balance, participation level, satisfaction with occupation and performed roles and community integration) after the COT-MHABI process; (iii) to analyse the impact of quality of life on satisfaction with occupations performed by this population. A non-randomised controlled clinical trial will be performed. Patients assigned to the experimental group will receive over one year of on-site and telematic occupational therapy sessions, 16 sessions on average. Variables such as quality of life, community integration or satisfaction with occupational performance will be collected at baseline, 6, and 12 months. DISCUSSION The needs for the dual mental/ABI population in their reintegration into the community are related to the associated deficits and to the absence of specialised services for the complexity of this patient profile. Few studies consider the coexistence of mental health and ABI issues. The COT-MHABI protocol is proposed to provide continuity to the community needs of this population, conceptualised from occupational participation, person-centred and focused on meaningful activities. CLINICAL TRIAL REGISTRATION Trial identifier and registry name ClinicalTrials.gov ID: NCT04586842 https://clinicaltrials.gov/ct2/show/NCT04586842?term=252136&draw=2&rank=1; Pre-results; Community-based Occupational Therapy Intervention on Mental Health for People With Acquired Brain Injury (COT-MHABI).
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Affiliation(s)
- Marco Antonio Raya-Ruiz
- Faculty of Health Science and Welfare, Social Sciences and Community Health Department, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Specialised Support and Assessment Team (EASE), Institut Guttmann, Badalona, Spain
| | | | | | - Laura Vidaña-Moya
- Research Group GrEUIT., Escola Universitària d’Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Spain
| | | | - José Antonio Merchán-Baeza
- Faculty of Health Science and Welfare, Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- * E-mail:
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Martin RJ, Chaney BH. Exploration of the Relationship Between Concussions and Depression Symptoms, Anxiety Symptoms, and Hazardous Drinking Among a Sample of College Students. J Dual Diagn 2022; 18:220-227. [PMID: 30183574 DOI: 10.1080/15504263.2018.1473906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: In clinical and athlete populations, research has found that experiencing a concussion (or traumatic brain injury) is correlated with experiencing other psychiatric conditions, including depression and alcohol problems. However, less is known about concussion comorbidity in other population segments. The purpose of this study is to examine the relationships between concussions and depression symptoms, anxiety symptoms, and hazardous drinking among a large sample of college students (N = 1776) enrolled in a mandatory health course. Methods: This study used an online health survey to examine concussion frequency (informal and formal diagnoses), sports-related concussions, depression symptoms, anxiety symptoms, and hazardous drinking in the sample. Bivariate and multivariate analyses were conducted to examine comorbid relationships between concussion frequency and the dependent variables of interest (anxiety symptoms, depression symptoms, and hazardous drinking). Results: We found that 691 (39.1%) participants indicated having at least one concussion. Analyses indicated that concussion frequency scores of both formal or informal diagnoses were significantly associated with scores of depression symptoms, anxiety symptoms, and hazardous drinking. When examining concussion frequency scores of only formal diagnoses, only hazardous drinking evidenced a statistically significant relationship. In addition, participants who had a sports concussion had significantly higher concussion frequency scores and hazardous drinking scores than those who have had a concussion that was not sport-related. Conclusions: The comorbid concussion relationships found in this study are consistent with those observed in clinical and athlete populations. It is important for college health professionals to be aware that concussion comorbidity is not limited to the athlete population and can impact the entire student body.
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Affiliation(s)
- Ryan J Martin
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA
| | - Beth H Chaney
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA
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Salas CE, Rojas-Líbano D, Castro O, Cruces R, Evans J, Radovic D, Arévalo-Romero C, Torres J, Aliaga Á. Social isolation after acquired brain injury: Exploring the relationship between network size, functional support, loneliness and mental health. Neuropsychol Rehabil 2022; 32:2294-2318. [PMID: 34139944 DOI: 10.1080/09602011.2021.1939062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Social isolation can be a consequence of acquired brain injury (ABI). Few studies have examined the relationship between social isolation and mental health after ABI. In this cross-sectional and case-control study, we compared 51 ABI survivors and 51 matched healthy controls on measures of social isolation (network size, social support and loneliness) mental health and mental health problems. We explored the relationship between structural, functional and subjective components of social isolation and examined whether they were associated with mental health outcomes. No group differences were found on size of the network and perceived social support. The ABI group exhibited marginally higher levels of loneliness. The ABI group presented higher levels of depression, lower levels of quality of life and emotional wellbeing. In both groups, perception of social support was inversely related to subjective experience of loneliness. The relationship between network size and loneliness was only significant in the ABI group. Only loneliness significantly predicted quality of life, emotional wellbeing, depression and anxiety in people with brain injury. The relationship between social isolation variables in ABI is discussed, as well as the theoretical and clinical implications of focusing on loneliness to improve mental health after brain injury.
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Affiliation(s)
- Christian E Salas
- Centre for Research in Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile.,Clinical Neuropsychology Unit, Faculty of Psychology, Diego Portales University, Santiago, Chile
| | - Daniel Rojas-Líbano
- Centre for Research in Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile
| | - Osvaldo Castro
- School of Occupational Therapy, Universidad Autónoma de Chile, Santiago, Chile
| | - Ramiro Cruces
- Clinical Neuropsychology Unit, Faculty of Psychology, Diego Portales University, Santiago, Chile
| | - Jonathan Evans
- Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Darinka Radovic
- Faculty of Physical and Mathematical Sciences, University of Chile, Santiago, Chile
| | - Camilo Arévalo-Romero
- Centre for Research in Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile
| | - Julio Torres
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Department of Neuroscience, Faculty of Medicine, University of Chile, Santiago, Chile.,Service of Physical and Rehabilitation Medicine, Clínica Davila, Santiago Chile
| | - Álvaro Aliaga
- Clinical Neuropsychology Unit, Faculty of Psychology, Diego Portales University, Santiago, Chile
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Olsen CM, Herrold AA, Conti AC, Vonder Haar C. Editorial: Behavioral outcomes of traumatic brain injury. Front Behav Neurosci 2022; 16:1010395. [PMID: 36160681 PMCID: PMC9490366 DOI: 10.3389/fnbeh.2022.1010395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Christopher M. Olsen
- Department of Pharmacology and Toxicology, Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Amy A. Herrold
- Research Service, Edward Hines Jr., VA Hospital, Hines, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Alana C. Conti
- John D. Dingell VA Medical Center Detroit, MI, United States
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Cole Vonder Haar
- Department of Neuroscience, Ohio State University, Wexner Medical Center, Columbus, OH, United States
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Garduño-Ortega O, Li H, Smith M, Yao L, Wilson J, Zarate A, Bushnik T. Assessment of the individual and compounding effects of marginalization factors on injury severity, discharge location, recovery, and employment outcomes at 1 year after traumatic brain injury. Front Neurol 2022; 13:942001. [PMID: 36090882 PMCID: PMC9462705 DOI: 10.3389/fneur.2022.942001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this study is to examine the effect of eight distinct marginalized group memberships and explore their compounding effect on injury severity, recovery, discharge location, and employment outcomes 1-year after traumatic brain injury (TBI). Methods Individuals with medically confirmed, complicated mild-severe TBI (N = 300) requiring inpatient rehabilitation care between the ages of 18 and 65 were recruited at two urban (public and private) health systems between 2013 and 2019. Data were collected from self-report and medical record abstraction. Marginalized group membership (MGM) includes racial and ethnic minority status, less than a high school diploma/GED, limited English proficiency, substance abuse, homelessness, psychiatric hospitalizations, psychiatric disorders, and incarceration history. Membership in four or more of these groups signifies high MGM. In addition, these factors were explored individually. Unadjusted and adjusted linear and logistic regressions and Kruskal–Wallis tests were used to assess the associations of interest in RStudio. Results After adjusting for age, sex, and cause of injury, compared to TBI patients with low MGM, those with high MGM experience significantly longer post-traumatic amnesia (95% CI = 2.70, 16.50; p = 0.007) and are significantly more likely to have a severe TBI (per the Glasgow-Coma Scale) (95% CI = 1.70, 6.10; p ≤ 0.001) than a complicated mild-moderate injury. Individuals with high MGM also are significantly less likely to be engaged in competitive paid employment 1 year after injury (95% CI = 2.40, 23.40; p = 0.001). Patients with high MGM are less likely to be discharged to the community compared to patients with low MGM, but this association was not significant (95% CI = 0.36, 1.16; p = 0.141). However, when assessing MGMs in isolation, certain associations were not significant in unadjusted or adjusted models. Conclusion This exploratory study's findings reveal that when four or more marginalization factors intersect, there is a compounding negative association with TBI severity, recovery, and employment outcomes. No significant association was found between high MGM and discharge location. When studied separately, individual MGMs had varying effects. Studying marginalization factors affecting individuals with TBI has critical clinical and social implications. These findings underline the importance of addressing multidimensional factors concurrent with TBI recovery, as the long-term effects of TBI can place additional burdens on individuals and their economic stability.
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Affiliation(s)
- Olga Garduño-Ortega
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
- *Correspondence: Olga Garduño-Ortega
| | - Huihui Li
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Michelle Smith
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Lanqiu Yao
- Department of Population Health, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Judith Wilson
- Occupational Therapy Department, Bellevue Hospital, Health and Hospitals, New York, NY, United States
| | - Alejandro Zarate
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Tamara Bushnik
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
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van der Vlegel M, Mikolić A, Lee Hee Q, Kaplan ZLR, Retel Helmrich IRA, van Veen E, Andelic N, Steinbuechel NV, Plass AM, Zeldovich M, Wilson L, Maas AIR, Haagsma JA, Polinder S. Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study. Injury 2022; 53:2774-2782. [PMID: 35725508 DOI: 10.1016/j.injury.2022.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/11/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI. METHODS We used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury. RESULTS Of 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms. CONCLUSION The rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.
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Affiliation(s)
- Marjolein van der Vlegel
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Ana Mikolić
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Quentin Lee Hee
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Z L Rana Kaplan
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Isabel R A Retel Helmrich
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Ernest van Veen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Intensive Care Adults, Rotterdam, the Netherlands
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, 0424 Oslo, Norway
| | - Nicole V Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/ Georg-August-University, Göttingen, Germany
| | - Anne Marie Plass
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/ Georg-August-University, Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen (UMG)/ Georg-August-University, Göttingen, Germany
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
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Neumann D, Juengst SB, Bombardier CH, Finn JA, Miles S, Zhang Y, Kennedy R, Rabinowitz AR, Thomas A, Dreer LE. Anxiety Trajectories the First 10 Years Following a Traumatic Brain Injury (TBI): A TBI Model Systems Study. Arch Phys Med Rehabil 2022; 103:2105-2113. [PMID: 35905772 DOI: 10.1016/j.apmr.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/27/2022] [Accepted: 07/02/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Determine anxiety trajectories and predictors up to 10 years post-traumatic brain injury (TBI). DESIGN Prospective longitudinal, observational study. SETTING Inpatient rehabilitation centers. PARTICIPANTS 2,836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had ≥2 anxiety data collection points. MAIN OUTCOME MEASURE Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups. RESULTS Linear mixed models showed higher GAD-7 scores were associated with Black race (p<.001), public insurance (p<.001), pre-injury mental health treatment (p<.001), 2 additional TBIs with loss of consciousness (LOC) (p=.003), violent injury (p=.047), and more years post-TBI (p=.023). An interaction between follow-up year and age was also related to GAD-7 scores (p=.006). A latent class mixed model identified three anxiety trajectories: low-stable (n=2,195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing groups had ≥mild GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16). CONCLUSIONS A substantial minority of participants had anxiety symptoms that either increased (10%) or decreased (13%) over 10 years, but never decreased below mild anxiety. Risk factors of anxiety included indicators of socioeconomic disadvantage (public insurance) and racial inequities (Black race) as well as having had pre-injury mental health treatment and two prior TBIs. Awareness of these risk factors may lead to identifying and proactively referring susceptible individuals to mental health services.
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Affiliation(s)
- Dawn Neumann
- Associate Professor, Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation, Indianapolis, IN; Research Director, Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN 46254.
| | - Shannon B Juengst
- University of Texas Southwestern Medical Center, Department of Physical Medicine & Rehabilitation
| | | | - Jacob A Finn
- Rehabilitation & Extended Care, Minneapolis VA Health Care System, Department of Psychiatry & Behavioral Sciences, University of Minnesota
| | - Shannon Miles
- James A. Haley Veterans' Hospital, Tampa, FL and Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Yue Zhang
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care
| | - Richard Kennedy
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care
| | | | - Amber Thomas
- Spaulding Rehabilitation Hospital, Harvard Medical School, Department of Physical Medicine and Rehabilitation, Boston, MA
| | - Laura E Dreer
- University of Alabama at Birmingham, Departments of Ophthalmology & Visual Sciences & Physical Medicine & Rehabilitation
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Paasila JM, Smith E, Daher M, Simpson GK. Reasons for living, positive psychological constructs and their relationship with suicide ideation in people with moderate to severe traumatic brain injury: A cross-sectional study. Neuropsychol Rehabil 2022; 32:2125-2146. [PMID: 35862622 DOI: 10.1080/09602011.2022.2100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Positive psychological constructs such as reasons for living, self-esteem and resilience have previously been shown to act as protective psychological barriers against negative psychological outcomes, including suicide ideation in both clinical populations and the general population. This study aims to explore the positive psychological constructs of reasons for living, self-esteem, resilience and their relationship with suicide ideation and predictors of suicide ideation (depression, hopelessness) for N = 50 people who have a severe TBI and are currently receiving community rehabilitation at Liverpool Brain Injury Rehabilitation Unit (LBIRU), NSW. Results indicated good reliability for the use of the RFLI with people who have TBI, with the most frequently endorsed subscale (range 0-5) being "survival and coping beliefs" (4.7 ± 1.0) and the least frequently being "fear of suicide" (2.2 ± 1.1). The shortened version of the RFLI (BRFLI) also displayed good reliability. Positive psychological constructs (reasons for living, resilience, self-esteem) were all significantly inversely associated with suicide and suicide predictors (depression, hopelessness). This study suggests that positive psychological constructs can act as a buffer against suicide ideation after moderate to severe TBI.
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Affiliation(s)
- Josephine M Paasila
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Psychology, Western Sydney University, Sydney, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Evelyn Smith
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Rivera D, Greving S, Arango-Lasprilla JC, von Steinbuechel N, Zeldovich M. Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study. J Clin Med 2022; 11:jcm11144090. [PMID: 35887853 PMCID: PMC9322034 DOI: 10.3390/jcm11144090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months post-injury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI.
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Affiliation(s)
- Diego Rivera
- Department of Health Sciences, Public University of Navarre, Arrosadia Campus, 31006 Pamplona, Spain;
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea Street 3, 31008 Pamplona, Spain
| | - Sven Greving
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
| | | | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
- Correspondence:
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Braga MFM, Juranek J, Eiden LE, Li Z, Figueiredo TH, de Araujo Furtado M, Marini AM. GABAergic circuits of the basolateral amygdala and generation of anxiety after traumatic brain injury. Amino Acids 2022; 54:1229-1249. [PMID: 35798984 DOI: 10.1007/s00726-022-03184-y] [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: 04/19/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury (TBI) has reached epidemic proportions around the world and is a major public health concern in the United States. Approximately 2.8 million individuals sustain a traumatic brain injury and are treated in an Emergency Department yearly in the U.S., and about 50,000 of them die. Persistent symptoms develop in 10-15% of the cases including neuropsychiatric disorders. Anxiety is the second most common neuropsychiatric disorder that develops in those with persistent neuropsychiatric symptoms after TBI. Abnormalities or atrophy in the temporal lobe has been shown in the overwhelming number of TBI cases. The basolateral amygdala (BLA), a temporal lobe structure that consolidates, stores and generates fear and anxiety-based behavioral outputs, is a critical brain region in the anxiety circuitry. In this review, we sought to capture studies that characterized the relationship between human post-traumatic anxiety and structural/functional alterations in the amygdala. We compared the human findings with results obtained with a reproducible mild TBI animal model that demonstrated a direct relationship between the alterations in the BLA and an anxiety-like phenotype. From this analysis, both preliminary insights, and gaps in knowledge, have emerged which may open new directions for the development of rational and more efficacious treatments.
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Affiliation(s)
- Maria F M Braga
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Jenifer Juranek
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77030, USA
| | - Lee E Eiden
- Section On Molecular Neuroscience, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Zheng Li
- Section On Synapse Development and Plasticity, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Taiza H Figueiredo
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Marcio de Araujo Furtado
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Ann M Marini
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Effects of animal-assisted psychotherapy incorporating mindfulness and self-compassion in neurorehabilitation: a randomized controlled feasibility trial. Sci Rep 2022; 12:10898. [PMID: 35764668 PMCID: PMC9240064 DOI: 10.1038/s41598-022-14584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Transdiagnostic psychotherapeutic approaches are increasingly used in neurorehabilitation to address psychological distress. Animal-assistance is thought to increase efficacy. The present study evaluates a psychotherapeutic mindfulness- and self-compassion-based group intervention (MSCBI) with and without animal-assistance for patients with acquired brain injury. Patients (N = 31) were randomly assigned to the 6-week intervention with (n = 14) or without animal-assistance (n = 17). Primary outcome was psychological distress at post- and follow-up treatment, secondary outcomes were changes within-session of patients’ emotional states, adherence to treatment and attrition. Psychological distress significantly decreased in both groups from pre- to follow-up treatment with no difference between groups. Patients in the animal-assisted MSCBI group reported significantly higher increases in feeling secure, accepted, comforted, grateful, motivated and at ease during the sessions compared to patients in the MSCBI group without animal-assistance. Adherence to sessions was significantly higher in the animal-assisted MSCBI group. Attrition did not significantly differ between groups. Our results show that both MSCBIs with and without animal-assistance are feasible and effective in reducing psychological distress in patients with acquired brain injury. The significant changes within-sessions mainly in relationship-based emotional states and the higher treatment adherence suggest additional effects of animal-assistance. Animal-assistance might increase acceptability and patients’ commitment to psychotherapy.
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Uiterwijk D, Stargatt R, Crowe SF. Objective Cognitive Outcomes and Subjective Emotional Sequelae in Litigating Adults with a Traumatic Brain Injury: The Impact of Performance and Symptom Validity Measures. Arch Clin Neuropsychol 2022; 37:1662-1687. [PMID: 35704852 DOI: 10.1093/arclin/acac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examined the relative contribution of performance and symptom validity in litigating adults with traumatic brain injury (TBI), as a function of TBI severity, and examined the relationship between self-reported emotional symptoms and cognitive tests scores while controlling for validity test performance. METHOD Participants underwent neuropsychological assessment between January 2012 and June 2021 in the context of compensation-seeking claims related to a TBI. All participants completed a cognitive test battery, the Personality Assessment Inventory (including symptom validity tests; SVTs), and multiple performance validity tests (PVTs). Data analyses included independent t-tests, one-way ANOVAs, correlation analyses, and hierarchical multiple regression. RESULTS A total of 370 participants were included. Atypical PVT and SVT performance were associated with poorer cognitive test performance and higher emotional symptom report, irrespective of TBI severity. PVTs and SVTs had an additive effect on cognitive test performance for uncomplicated mTBI, but less so for more severe TBI. The relationship between emotional symptoms and cognitive test performance diminished substantially when validity test performance was controlled, and validity test performance had a substantially larger impact than emotional symptoms on cognitive test performance. CONCLUSION Validity test performance has a significant impact on the neuropsychological profiles of people with TBI, irrespective of TBI severity, and plays a significant role in the relationship between emotional symptoms and cognitive test performance. Adequate validity testing should be incorporated into every neuropsychological assessment, and associations between emotional symptoms and cognitive outcomes that do not consider validity testing should be interpreted with extreme caution.
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Affiliation(s)
- Daniel Uiterwijk
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Robyn Stargatt
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Simon F Crowe
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
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