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Agimi Y, Hai T, Gano A, Stuessi K, Gold J, Kaufman R, McKinney G. Clinical Trajectories of Comorbidity Associated With Military-Sustained Mild Traumatic Brain Injury: Pre- and Post-Injury. J Head Trauma Rehabil 2024:00001199-990000000-00150. [PMID: 38758066 DOI: 10.1097/htr.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND AND OBJECTIVE In the US military, traumatic brain injury (TBI) is of distinct importance, at home and in the deployed setting, and is considered a "signature injury of the wars in Afghanistan and Iraq." Since 2000, an estimated 468 424 service members (SMs) have been diagnosed with at least one TBI. We examined the clinical trajectories of a group of 18 comorbidities before and after a military-sustained mild TBI (mTBI). METHODS Without making assumptions on causality, a group of 18 conditions often co-occurring with mTBI were identified through literature review and TBI subject matter workgroup consensus. Using data from Military Health System Data Repository, we identified SMs whose first lifetime military mTBI occurred between October 1, 2016, and October 30, 2019. Correlation analyses were used to determine the linear relationship between comorbidities prior to and after mTBI diagnosis. Changes in the period prevalence of comorbidities was calculated. RESULTS We identified 42 018 SMs with a first lifetime military mTBI, of which 77.6% had at least one comorbidity. Identified SMs were mostly young (46.1% ages 18-24 years), male (81.4%), and White (64.1%). Up to 180 days prior to an mTBI, the most frequently identified conditions were sleep-related conditions (21.7%), headaches (19.4%), posttraumatic stress disorders (PTSDs) (17.8%), anxiety disorders (11.3%), and cervicogenic disorders (eg, cervicalgia) (10.9%). In the period following mTBI diagnosis, the prevalence of diagnosed conditions increased, especially for visual disturbances (327.2%), cognitive conditions (313.9%), vestibular conditions (192.6%), those related to headache (152.2%), and hearing (72.9%). Sleep-related conditions showed moderate positive correlation with a group of co-occurring conditions, led by cognitive conditions (ϕc = 0.50), anxiety disorders (ϕc = 0.42), PTSDs (ϕc =0.43), and headaches and related conditions (ϕc = 0.38). CONCLUSION Results indicate that caring for SMs with mild TBI requires a holistic approach, one that considers the complex nature of SM conditions, prior to sustaining their mTBI, as well as after injury. We found a complex correlation of conditions that suggest SMs with mTBI are undergoing a multifaceted experience, one that may require the development of a targeted multidimensional clinical practice recommendation and practice.
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Affiliation(s)
- Yll Agimi
- Author Affiliations: Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, Maryland (Drs Agimi, Stuessi, Gold, and McKinney and Mss Hai, Gano, and Kaufman); and General Dynamics Information Technology, Falls Church, Virginia (Drs Agimi, Stuessi, and Gold and Mss Hai, Gano, and Kaufman)
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Fekih-Romdhane F, Malaeb D, Farah N, Stambouli M, Cheour M, Obeid S, Hallit S. The relationship between cyberbullying perpetration/victimization and suicidal ideation in healthy young adults: the indirect effects of positive and negative psychotic experiences. BMC Psychiatry 2024; 24:121. [PMID: 38355556 PMCID: PMC10865539 DOI: 10.1186/s12888-024-05552-2] [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: 06/11/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Even though not all cyber bullies or victims think of (or consider) suicide, they clearly appear to be at an increased risk. One possible strategy to reduce suicide risk is to decrease cyberbullying occurrence; but this approach has its limitations, as it is certainly an illusion to believe that cyberbullying could be controlled or eliminated in a digitalized world. Another alternative and interesting strategy is to consider mediating factors that may indirectly affect suicidality. To this end, our purpose was to test the hypothesis that positive and negative psychotic experiences (PEs) mediate the relationship from cyberbullying perpetration/victimization to suicidal ideation (SI). METHOD The study followed a cross-sectional design, and was conducted during the period from June to September 2022. A total of 3103 healthy community participants from Lebanon were included (mean age 21.73 ± 3.80 years, 63.6% females). RESULTS After adjusting over potential confounders, mediation analysis models showed that both positive and negative PEs partially mediated the associations between cyberbullying victimization/perpetration and SI. Higher cyberbullying perpetration and victimization were significantly associated with greater positive and negative PEs; more severe positive and negative PEs were significantly associated with higher levels of SI. Higher cyberbullying victimization and perpetration were significantly and directly associated with higher levels of SI. CONCLUSION In light of our preliminary findings, there appears to be an urgent need for a new focus on carefully assessing and addressing attenuated psychotic symptoms in healthy individuals engaged in cyberbullying either as victims or bullies and who present with SI. It is important that school counselors and decision-makers consider a holistic approach taking into account both external/environmental (bullying) and internal/individual (PEs) factors in their suicide prevention programs. Future longitudinal research in larger samples are still required to confirm our findings and further elucidate the mechanisms underlying the relationship between cyberbullying and suicide.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, 2010, Manouba, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Manel Stambouli
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Majda Cheour
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon.
- Psychology Department, College of Humanities, Effat University, 21478, Jeddah, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Miller GF, Zhou H, Peterson AB, Swedo E, Holland K, Kresnow MJ. Association between traumatic brain injury and suicidality using a mediation approach and MarketScan. Inj Prev 2023; 29:246-252. [PMID: 36600521 PMCID: PMC10198876 DOI: 10.1136/ip-2022-044697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Negative outcomes, including suicidal ideation/attempts, are a major public health concern, particularly among individuals who sustain a traumatic brain injury (TBI). TBI is associated with high rates of postinjury substance use, psychiatric disorders, post-traumatic stress disorder and sleep disturbances. This study examines the mediation effects of substance use, psychiatric disorder and sleep disorder on the associations between TBI and suicidal ideation/attempts. METHODS A matched case-control study using data from MarketScan databases for private health insurance and Medicaid from October 2015 to December 2018 estimated the association between TBI and suicidal ideation/attempts using a mediation approach. Individuals less than 65 years of age were included. RESULTS In the Medicaid sample, psychiatric disorders mediated 22.4% of the total effect between TBI and suicidal ideation/attempt, while substance use disorders other than opioid use disorder mediated 7.47%. In the private health insurance sample, psychiatric disorders mediated 3.97% of the total effect, opioid use disorders mediated 2.08% of the total effect and sleep disorder mediated 1.25% of the total effect. CONCLUSIONS Mediators explained less than 30% of the relationship between TBI and suicidal ideation/attempt. Findings reinforce the importance of primary prevention of TBI and monitoring patients with a TBI for risk of suicide in the first 6-12 months following injury.
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Affiliation(s)
- Gabrielle F Miller
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hong Zhou
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexis B Peterson
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Swedo
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kristin Holland
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marcie-Jo Kresnow
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Farah N, Obeid S, Malaeb D, Haddad C, Fekih-Romdhane F, Hallit S. Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults. BMC Psychiatry 2023; 23:272. [PMID: 37081441 PMCID: PMC10116113 DOI: 10.1186/s12888-023-04778-w] [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] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults. METHODS A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis. RESULTS A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI. CONCLUSION These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.
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Affiliation(s)
- Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Miles SR, Martindale SL, Flanagan JC, Troyanskaya M, Reljic T, Gilmore AK, Wyant H, Nakase-Richardson R. Putting the pieces together to understand anger in combat veterans and service members: Psychological and physical contributors. J Psychiatr Res 2023; 159:57-65. [PMID: 36657315 DOI: 10.1016/j.jpsychires.2023.01.013] [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] [Received: 09/13/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for the association between PTSD and anger, in addition to the association between pain interference and anger. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Additionally, treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference.
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Affiliation(s)
- Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Sarah L Martindale
- W.G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | - Maya Troyanskaya
- Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Tea Reljic
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Hannah Wyant
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Traumatic Brain Injury Center of Excellence, Defense Health Agency, James A. Haley Veterans' Hospital, Tampa, FL, USA; Pulmonary and Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
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Jin Y, Xu S, Hu Z, Li J, Li H, Wang X, Sun X, Wang Y. Co-occurrence of PTSD and affective symptoms in a large sample with childhood trauma subtypes: A network analysis. Front Public Health 2023; 11:1093687. [PMID: 36960378 PMCID: PMC10028141 DOI: 10.3389/fpubh.2023.1093687] [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: 11/09/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
Background Exposure to childhood trauma (CT) is associated with various deleterious mental health outcomes, increasing the risk of suicidal behaviors. The objective of this study is to investigate the different effects of three forms of CT, including emotional abuse (EA), physical abuse (PA), and sexual abuse (SA), on potential psychopathological symptoms among college students. Methods A total of 117,769 students from 63 Chinese colleges participated in this study. There were 1,191 participants in the EA group (1.24%; 95% CI: 1.17-1.31%), 1,272 participants in the PA group (1.32%; 95% CI: 1.25-1.40%), and 3,479 participants in the SA group (3.62%; 95% CI: 3.50-3.73%). CT was measured by the Childhood Trauma Questionnaire-Short Form. Psychopathological symptoms (i.e., depression, anxiety, and PTSD) were measured by the PHQ-9, GAD-7, and Trauma Screening Questionnaire, respectively. Network analysis was applied to analyze psychopathological symptoms between three CT subgroups (EA, PA, and SA). The associations and centralities of the networks were calculated, and the network characteristics of the three subgroups were contrasted. Results The main symptoms across all three groups are uncontrollable worry, sad mood, irritability, and fatigue, which indicates these core symptoms play essential roles in maintaining the whole psychological symptoms network. Furthermore, there are significant differences in symptom associations between the three groups. The comparison of network structures of the three groups shows that the SA group reports more PTSD symptoms, the EA group reports more suicide-related symptoms, and the PA group reports more anxiety symptoms. Conclusion Specific symptoms were disclosed across each group by the distinctive core psychopathological symptoms found in the CT subgroup networks. The present study's findings show different associations between CT and psychopathology and may help classify potential diagnostic processes. Therefore, local governments and academic institutions are recommended for early intervention to promote the psychological well-being of CT survivors.
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Affiliation(s)
- Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
- *Correspondence: Shicun Xu
| | - Zhishan Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Hui Li
- School of Public Health, Jilin University, Changchun, China
| | - Xiaofeng Wang
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Xi Sun
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
- Yuanyuan Wang
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Huckhagel T, Riedel C, Rohde V, Lefering R. Cranial nerve injuries in patients with moderate to severe head trauma - Analysis of 91,196 patients from the TraumaRegister DGU® between 2008 and 2017. Clin Neurol Neurosurg 2021; 212:107089. [PMID: 34902753 DOI: 10.1016/j.clineuro.2021.107089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) constitutes a major cause of trauma-related disability and mortality. The epidemiology and implications of associated cranial nerve injuries (CNI) in moderate to severe TBI are largely unknown. We aimed to determine the incidence of CNI in a large European cohort of TBI patients as well as clinical differences between TBI cases with and without concomitant CNI (CNI vs. control group) by means of a multinational trauma registry. METHODS The TraumaRegister DGU® was evaluated for trauma patients with head injuries ≥ 2 Abbreviated Injury Scale, who had to be treated on intensive care units after emergency admission to European hospitals between 2008 and 2017. CNI and control cases were compared with respect to demographic, clinical, and outcome variables. RESULTS 1.0% (946 of 91,196) of TBI patients presented with additional CNI. On average, CNI patients were younger than control cases (44.3 ± 20.6 vs. 51.8 ± 23.0 years) but did not differ regarding sex distribution (CNI 69.4% males vs. control 69.1%). Traffic accidents were encountered more frequently in CNI cases (52.3% vs. 46.7%; p < 0.001; chi-squared test) and falls more commonly in the control group (45.2% vs. 37.1%; p < 0.001). CNI patients suffered more frequently from concomitant face injuries (28.2% vs. 17.5%; p < 0.001) and skull base fractures (51.0% vs. 23.5%; p < 0.001). Despite similar mean Injury Severity Score (CNI 21.8 ± 11.3; control 21.1 ± 11.7) and Glasgow Coma Scale score (CNI 10.9 ± 4.2, control 11.1 ± 4.4), there was a considerably higher proportion of anisocoria in CNI patients (20.1% vs. 11.2%; p < 0.001). Following primary treatment, 50.8% of CNI and 35.5% of control cases showed moderate to severe disability (Glasgow Outcome Scale score 3-4; p < 0.001). CONCLUSION CNI rarely occur in the context of TBI. When present, they indicate a higher likelihood of functional impairment following primary care and complicating skull base fractures should be suspected.
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Affiliation(s)
- T Huckhagel
- University Medical Center Göttingen, Department of Neuroradiology, Göttingen, Germany; University Medical Center Hamburg, Department of Neurosurgery, Hamburg, Germany.
| | - C Riedel
- University Medical Center Göttingen, Department of Neuroradiology, Göttingen, Germany
| | - V Rohde
- University Medical Center Göttingen, Department of Neurosurgery, Göttingen, Germany
| | - R Lefering
- University of Witten/Herdecke, Institute for Research in Operative Medicine, Cologne, Germany
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Dickerson MR, Murphy SF, Urban MJ, White Z, VandeVord PJ. Chronic Anxiety- and Depression-Like Behaviors Are Associated With Glial-Driven Pathology Following Repeated Blast Induced Neurotrauma. Front Behav Neurosci 2021; 15:787475. [PMID: 34955781 PMCID: PMC8703020 DOI: 10.3389/fnbeh.2021.787475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/19/2021] [Indexed: 12/27/2022] Open
Abstract
Long-term neuropsychiatric impairments have become a growing concern following blast-related traumatic brain injury (bTBI) in active military personnel and Veterans. Neuropsychiatric impairments such as anxiety and depression are common comorbidities that Veterans report months, even years following injury. To understand these chronic behavioral outcomes following blast injury, there is a need to study the link between anxiety, depression, and neuropathology. The hippocampus and motor cortex (MC) have been regions of interest when studying cognitive deficits following blast exposure, but clinical studies of mood disorders such as major depressive disorder (MDD) report that these two regions also play a role in the manifestation of anxiety and depression. With anxiety and depression being common long-term outcomes following bTBI, it is imperative to study how chronic pathological changes within the hippocampus and/or MC due to blast contribute to the development of these psychiatric impairments. In this study, we exposed male rats to a repeated blast overpressure (~17 psi) and evaluated the chronic behavioral and pathological effects on the hippocampus and MC. Results demonstrated that the repeated blast exposure led to depression-like behaviors 36 weeks following injury, and anxiety-like behaviors 2-, and 52-weeks following injury. These behaviors were also correlated with astrocyte pathology (glial-fibrillary acid protein, GFAP) and dendritic alterations (Microtubule-Associated Proteins, MAP2) within the hippocampus and MC regions at 52 weeks. Overall, these findings support the premise that chronic glial pathological changes within the brain contribute to neuropsychiatric impairments following blast exposure.
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Affiliation(s)
- Michelle R. Dickerson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Susan F. Murphy
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Michael J. Urban
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Zakar White
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Pamela J. VandeVord
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
- Salem VA Medical Center, Salem, VA, United States
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The Relationship Between Cognitive Functioning and Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder in Adults with a Traumatic Brain Injury: a Meta-Analysis. Neuropsychol Rev 2021; 32:758-806. [PMID: 34694543 DOI: 10.1007/s11065-021-09524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.
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Abstract
Neurobehavioral sequelae after mild traumatic brain injury are multifactorial, often necessitating a multidisciplinary approach. Neurobehavioral sequelae generally resolve within 3 months; when more persistent, a search for contributing factors beyond a brain injury should be done. To accomplish this, a systematic and comprehensive evaluation is recommended to place the complaint in context of the patient's premorbid state. The treatment of neurobehavioral sequelae cannot be accomplished without a clear understanding of the underlying cause, and the treatment must be placed within a patient's social and functional framework. Normalizing the experience through education of patients and their families facilitates recovery.
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Affiliation(s)
- Megan E Solberg
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 East Evans Avenue, Denver, CO 80208, USA
| | - Silvana Riggio
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA; Department of Neurology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA; Department of Psychiatry, James J. Peters VAMC, 130 West Kingsbridge Road, Bronx, NY, USA.
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11
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Hai T, Agimi Y, Stout K. Prevalence of Comorbidities in Active and Reserve Service Members Pre and Post Traumatic Brain Injury, 2017-2019. Mil Med 2021; 188:e270-e277. [PMID: 34423819 PMCID: PMC9825245 DOI: 10.1093/milmed/usab342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To understand the prevalence of comorbidities associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military. METHODS Active and reserve SMs diagnosed with an incident TBI from January 2017 to October 2019 were selected. Nineteen comorbidities associated with TBI as identified in the literature and by clinical subject matter experts were described in this article. Each patient's medical encounters were evaluated from 6 months before to 2 years following the initial TBI diagnoses date in the Military Data Repository, if data were available. Time-to-event analyses were conducted to assess the cumulative prevalence over time of each comorbidity to the incident TBI diagnosis. RESULTS We identified 47,299 TBI patients, of which most were mild (88.8%), followed by moderate (10.5%), severe (0.5%), and of penetrating (0.2%) TBI severity. Two years from the initial TBI diagnoses, the top five comorbidities within our cohort were cognitive disorders (51.9%), sleep disorders (45.0%), post-traumatic stress disorder (PTSD; 36.0%), emotional disorders (22.7%), and anxiety disorders (22.6%) across severity groups. Cognitive, sleep, PTSD, and emotional disorders were the top comorbidities seen within each TBI severity group. Comorbidities increased pre-TBI to post-TBI; the more severe the TBI, the greater the prevalence of associated comorbidities. CONCLUSION A large proportion of our TBI patients are afflicted with comorbidities, particularly post-TBI, indicating many have a complex profile. The military health system should continue tracking comorbidities associated with TBI within the U.S. Military and devise clinical practices that acknowledge the complexity of the TBI patient.
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Affiliation(s)
- Tajrina Hai
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA,General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - Yll Agimi
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA,General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - Katharine Stout
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA
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12
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Hoffman AN, Watson S, Fanselow MS, Hovda DA, Giza C. Region-Dependent Modulation of Neural Plasticity in Limbic Structures Early after Traumatic Brain Injury. Neurotrauma Rep 2021; 2:200-213. [PMID: 33937912 PMCID: PMC8086520 DOI: 10.1089/neur.2020.0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Traumatic brain injury (TBI)-induced disruptions in synaptic function within brain regions and across networks in the limbic system may underlie a vulnerability for maladaptive plasticity and contribute to behavioral comorbidities. In this study we measured how synaptic proteins respond to lateral fluid percussion injury (FPI) brain regions known to regulate emotion and memory, including the basolateral amygdala (BLA), dorsal and ventral hippocampus (DH, VH), and medial prefrontal cortex (PFC). We investigated proteins involved in regulating plasticity, including synaptic glutamatergic a-amino-3-hydroxy5-methyl-4-isoxazolepropionic acid (AMPA; GluA1, GluA2) and N-methyl-D-aspartate (NMDA; NR1, NR2A, NR2B) receptor subunits as well as inhibitory gamma-aminobutyric acid (GABA) synthetic enzymes (GAD67, GAD65) via western blot. Adult male rats received a mild-moderate lateral FPI or sham surgery and ipsi- and contralateral BLA, DH, VH, and PFC were collected 6 h, 24 h, 48 h, and 7 days post-injury. In the ipsilateral BLA, there was a significant decrease in NR1 and GluA2 24 h after injury, whereas NR2A and NR2B were increased in the contralateral BLA at 48 h compared with sham. GAD67 was increased ipsilaterally at 24 h, but decreased contralaterally at 48 h in the BLA. In the DH, both NMDA (NR2A, NR2B) and GABA-synthetic (GAD65, GAD67) proteins were increased acutely at 6 h compared with sham. GAD67 was also robustly increased in the ipsilateral VH at 6 h. In the contralateral VH, NR2A significantly increased between 6 h and 24 h after FPI, whereas GAD65 was decreased across the same time-points in the contralateral VH. In the medial PFC at 24 h we saw bilateral increases in GAD67 and a contralateral decrease in GluA1. Later, there was a significant decrease in GAD67 in contralateral PFC from 48 h to 7 days post-injury. Collectively, these data suggest that lateral FPI causes a dynamic homeostatic response across limbic networks, leading to an imbalance of the proteins involved in plasticity in neural systems underlying cognitive and emotional regulation.
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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.,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
| | - Michael S Fanselow
- Department of Psychology, 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.,Department of Psychiatry and Biobehavioral Sciences, 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 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
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13
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Shultz SR, McDonald SJ, Corrigan F, Semple BD, Salberg S, Zamani A, Jones NC, Mychasiuk R. Clinical Relevance of Behavior Testing in Animal Models of Traumatic Brain Injury. J Neurotrauma 2020; 37:2381-2400. [DOI: 10.1089/neu.2018.6149] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sandy R. Shultz
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Stuart J. McDonald
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia
| | - Frances Corrigan
- Department of Anatomy, University of South Australia, Adelaide, South Australia, Australia
| | - Bridgette D. Semple
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Akram Zamani
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Nigel C. Jones
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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14
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Rowlands L, Coetzer R, Turnbull O. This time it's personal: reappraisal after acquired brain injury. Cogn Emot 2020; 35:305-323. [PMID: 33153409 DOI: 10.1080/02699931.2020.1839384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reappraisal is a widely investigated emotion regulation strategy, often impaired in those with acquired brain injury (ABI). Little is known, however, about the tools to measure this capacity in patients, who may find traditional reappraisal tasks difficult. Fifty-five participants with ABI, and thirty-five healthy controls (HCs), completed reappraisal tasks with personal and impersonal emotion elicitation components, questionnaires measuring reappraisal (the ERQ-CA), and neuropsychological assessment. The main findings demonstrated that both groups produced more reappraisals, and rated their reappraisal ideas as more effective for personal stimuli. The ABI group were significantly faster to generate reappraisals for personal, compared to impersonal, stimuli. Yet, participants with ABI performed worse than HCs on the majority of reappraisal components, across both reappraisal tasks. Results of regression analyses revealed significant relationships between certain measures of cognitive control and certain reappraisal components, which varied for the personal and impersonal reappraisal task. Notably, while inhibition predicted aspects of reappraisal in both the ABI and HC group, working memory was only related to reappraisal in participants with ABI. The study suggests that personal context plays a key role in reappraisal, and proposes a model to better understand the role of cognitive control across the reappraisal process.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
| | - Rudi Coetzer
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
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15
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Peppel LD, Ribbers GM, Heijenbrok-Kal MH. Pharmacological and Non-Pharmacological Interventions for Depression after Moderate-to-Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Neurotrauma 2020; 37:1587-1596. [DOI: 10.1089/neu.2019.6735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lianne D. Peppel
- Rijndam Rehabilitation, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Gerard M. Ribbers
- Rijndam Rehabilitation, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Majanka H. Heijenbrok-Kal
- Rijndam Rehabilitation, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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16
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Kwak EH, Wi S, Kim M, Pyo S, Shin YK, Oh KJ, Han K, Kim YW, Cho SR. Factors affecting cognition and emotion in patients with traumatic brain injury. NeuroRehabilitation 2020; 46:369-379. [PMID: 32310194 PMCID: PMC7306897 DOI: 10.3233/nre-192893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive and emotional disturbances are common serious issues in patients with traumatic brain injury (TBI). However, predictors associated with neuropsychological functions were not consistent. OBJECTIVE To investigate factors affecting cognition and emotion in patients with TBI, we evaluated executive function, memory, and emotion based on injury severity and lesion location. METHODS Neuropsychological outcomes of 80 TBI patients were evaluated via Wisconsin Card Sorting Test (WCST), Color Trail Test (CTT), Controlled Oral Word Association Test (COWAT), Everyday Memory Questionnaire (EMQ), Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), and Agitated Behavior Scale (ABS). WCST, CTT, and COWAT assessed executive function; EMQ assessed everyday memory; and GDS, STAI, and ABS assessed emotion. Patients were categorized according to lateralization of lesion and existence of frontal lobe injury. RESULTS Patients with longer duration of loss of consciousness (LOC) showed more severe deficits in everyday memory and agitated behaviors. The frontal lesion group showed poorer performance in executive function and higher agitation than the non-frontal lesion group. Patients with bilateral frontal lesion showed greater deficits in executive function and were more depressed than unilateral frontal lesion groups. Especially in those unilateral frontal lesion groups, right side frontal lesion group was worse on executive function than left side frontal lesion group. CONCLUSIONS Duration of LOC and lesion location are main parameters affecting executive function, everyday memory, and emotion in neuropsychological outcomes following TBI, suggesting that these parameters need to be considered for cognitive rehabilitation interventions.
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Affiliation(s)
- Eun Hee Kwak
- Department and Research Institute of Rehabilitation Medicine, Yonsei University Medical Center, Seoul, Korea.,Department of Psychology, Yonsei University, Seoul, Korea
| | - Soohyun Wi
- Department and Research Institute of Rehabilitation Medicine, Yonsei University Medical Center, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - MinGi Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University Medical Center, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soonil Pyo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University Medical Center, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon-Kyum Shin
- Department and Research Institute of Rehabilitation Medicine, Yonsei University Medical Center, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Ja Oh
- Department of Psychology, Yonsei University, Seoul, Korea
| | - Kyunghun Han
- Division of Sport science, Pusan National University, Busan, Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University Medical Center, Seoul, Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University Medical Center, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.,Graduate Program of Nano Science and Technology, Yonsei University College of Medicine, Seoul, Korea
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17
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Posttraumatic Stress Disorder Symptoms Contribute to Staff Perceived Irritability, Anger, and Aggression After TBI in a Longitudinal Veteran Cohort: A VA TBI Model Systems Study. Arch Phys Med Rehabil 2020; 101:81-88. [DOI: 10.1016/j.apmr.2019.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/25/2019] [Indexed: 11/20/2022]
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18
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Adshead CD, Norman A, Holloway M. The inter-relationship between acquired brain injury, substance use and homelessness; the impact of adverse childhood experiences: an interpretative phenomenological analysis study. Disabil Rehabil 2019; 43:2411-2423. [PMID: 31825694 DOI: 10.1080/09638288.2019.1700565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Acquired Brain Injuries, caused by a range of illnesses and injuries, can lead to long-term difficulties for individuals; mental health problems, cognitive and executive impairment and psychosocial problems including relationship breakdown, substance abuse and potentially homelessness. The study aimed to seek and gain a more definitive understanding of the inter-relationship of Acquired Brain Injury, substance abuse and homelessness by identifying key themes associated with the inter-relationship between these variables. MATERIALS AND METHODS The study recruited eight participants through homeless organisations and treatment centres. Participants were screened for suitability (Brain Injury Screening Index; Drug Abuse Screening Tool; Alcohol Use Disorders Identification Test and then participated in recorded semi-structured interviews, transcribed and analysed using Interpretative Phenomenological Analysis. RESULTS The study identified five master themes: Adverse Childhood Experiences and Trauma; Mental Health; Cognitive Decline and Executive Function; Services; Relationships. CONCLUSION Healthcare professionals need to engage with children, their families, and adults, who have been exposed to adverse childhood experiences and should employ routine screening tools for brain injury to ensure their presence is factored into developing appropriate models of intervention.IMPLICATIONS FOR REHABILITATIONNeed person-centred approaches to intervention for those with acquired brain injury who are homeless and have substance abuse issues.Need to screen for the presence of acquired brain injury when engaging with individuals who are homeless or have substance abuse.Need screening of acquired brain injury and adverse childhood experiences to improve access to services post-brain injury.
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Affiliation(s)
| | - Alyson Norman
- School of Psychology, University of Plymouth, Plymouth, UK
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19
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Barnett M, Reid L. The effectiveness of methylphenidate in improving cognition after brain injury in adults: a systematic review. Brain Inj 2019; 34:1-10. [PMID: 31526025 DOI: 10.1080/02699052.2019.1667538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: To conduct a systematic review investigating the effectiveness of methylphenidate in improving cognition following brain injury in an adult population.Data sources: CINAHL, PsychINFO, MEDLINE, and PubMed databases were searched for all relevant articles published from January 1980 up to December 2017.Study selection: Studies were included if participants had a diagnosis of new onset or previous acquired brain injury and were age 16 or over. Studies must have administered methylphenidate and measured its effectiveness on cognition using at least one measure of cognitive function.Data extraction: Data extracted included study design, sample size, participant characteristics, intervention method, outcome measures, and findings. The quality of included randomized controlled trials was assessed using the Physiotherapy Evidence Database. An overall level of evidence was assigned using a modified Sackett scale.Data synthesis: Included studies consisted of seven randomized controlled trials, two pre-post trials, one prospective controlled trial, and one case study. All included studies reported improved cognitive abilities following methylphenidate treatment post-injury.Conclusions: There is the strongest level of evidence (Level 1a) suggesting methylphenidate may alleviate cognitive impairments in adults with brain injury. However, longitudinal studies are warranted examining the effectiveness and safety of long-term methylphenidate use in this population.
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Affiliation(s)
- Megan Barnett
- Brain Injury Rehabilitation Centre, Murdostoun Brain Injury Rehabilitation & Neurological Care Centre, Wishaw, Scotland
| | - Louise Reid
- Brain Injury Rehabilitation Centre, Murdostoun Brain Injury Rehabilitation & Neurological Care Centre, Wishaw, Scotland
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20
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Van Praag DLG, Cnossen MC, Polinder S, Wilson L, Maas AIR. Post-Traumatic Stress Disorder after Civilian Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prevalence Rates. J Neurotrauma 2019; 36:3220-3232. [PMID: 31238819 PMCID: PMC6857464 DOI: 10.1089/neu.2018.5759] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a commonly diagnosed psychiatric disorder following traumatic brain injury (TBI). Much research on PTSD and TBI has focused on military conflict settings. Less is known about PTSD in civilian TBI. We conducted a systematic review and meta-analysis on the prevalence of PTSD after mild and moderate/severe TBI in civilian populations. We further aimed to explore the influence of methodological quality and assessment methods. A systematic literature search was performed on studies reporting on PTSD in civilian TBI, excluding studies on military populations. The risk of bias was assessed using the MORE (Methodological evaluation of Observational REsearch) checklist. Meta-analysis was conducted for overall prevalence rates for PTSD with sensitivity analyses for the severity of TBI. Fifty-two studies were included, of which 31 were graded as low risk of bias. Prevalence rates of PTSD in low risk of bias studies varied widely (2.6–36%) with a pooled prevalence rate of 15.6%. Pooled prevalence rates of PTSD for mild TBI (13.5%, 95% confidence interval [CI]: 11.7–15.3; I2 = 2%) did not differ from moderate/severe TBI (11.8, 95% CI: 7.5–16.1; I2 = 63%). Similar rates were reported in studies using different approaches and times of assessment. Although most studies that compared participants with TBI with trauma patients and healthy controls found no difference in prevalence rates of PTSD, a meta-analysis across studies revealed a higher prevalence of PTSD in patients with TBI (odds ratio [OR]: 1.73, 95% CI: 1.21–2.47). This review highlights variability between studies and emphasizes the need for higher-quality studies. Further research is warranted to determine risk factors for the development of PTSD after TBI.
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Affiliation(s)
- Dominique L G Van Praag
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maryse C Cnossen
- Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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21
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Vaughn MG, Salas-Wright CP, John R, Holzer KJ, Qian Z, Veeh C. Traumatic Brain Injury and Psychiatric Co-Morbidity in the United States. Psychiatr Q 2019; 90:151-158. [PMID: 30465326 DOI: 10.1007/s11126-018-9617-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The objective of the present study was to provide a nationally representative psychiatric epidemiologic investigation of traumatic brain injury (TBI) and its co-morbid conditions. Data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC-III) collected between 2012 and 2013 was used. Results indicated that TBI was significantly associated with any lifetime mental health (AOR = 2.32, 95% CI = 1.65-3.70), substance use disorder (AOR = 1.57-1.01-2.42), and violent (AOR = 1.65, 95% CI = 1.03-2.65) and nonviolent (AOR = 1.84, 95% CI = 1.25-2.70) criminal behaviors. In our study, TBI was highly comorbid with psychiatric disorders and especially antisocial behaviors, both violent and non-violent.
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Affiliation(s)
- Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Blvd, St. Louis, MO, 63103, USA.
| | | | - Rachel John
- School of Social Work, Boston University, Boston, MA, 02215, USA
| | - Katherine J Holzer
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Blvd, St. Louis, MO, 63103, USA
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, 63103, USA
| | - Christopher Veeh
- School of Social Work, University of Iowa, Iowa City, IA, 52242, USA
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22
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Silva MA, Dillahunt-Aspillaga C, Patel N, Garofano JS, Martinez KM, Lynn CA, Rechkemmer MB, Nakase-Richardson R. Functional Outcome and Mental Health Symptoms in Military Personnel and Veterans Pursuing Postsecondary Education After Traumatic Brain Injury: A VA TBI Model Systems Study. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2019. [DOI: 10.1891/2168-6653.33.1.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundTBI is a leading cause of disability among veterans and active duty military personnel, and presents an obstacle to community reintegration. Prior studies examining adult survivors of TBI pursuing postsecondary education have methodological flaws that limit the understanding the scope and severity of sequelae experienced by persons with TBI who attend college.ObjectiveTo describe (a) physical and cognitive functioning, and (b) postconcussion and mental health symptoms in veterans and military personnel (V/M) with traumatic brain injury (TBI) enrolled in postsecondary education programs after discharge from rehabilitation.MethodCross-sectional study. Participants were recruited from five Veterans Affairs (VA) Polytrauma Rehabilitation Centers, enrolled in the VA TBI Model Systems parent study, and attending school during follow-up (N= 155). Outcome measures included the Functional Independence Measure (FIM), Neurobehavioral Symptom Inventory (NSI), Post-traumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C), Patient Health Questionnaire-Depression (PHQ-9), and Generalized Anxiety Disorder Questionnaire (GAD-7).FindingsParticipants were mostly male (92.9%) and White (81.4%), with mild (40.0%), moderate (11.5%), severe (34.5%), or very severe TBI (23.0%). Depression, anxiety, PTSD, and postconcussion symptoms were lowest in participants with very severe TBI and highest in those with mild TBI. There were no significant differences in FIM across TBI severity levels.ConclusionThis study supports the need for rehabilitation counselors, educators, and administrators to prepare future practitioners to deliver tailored services to student V/M with TBI. These services can facilitate successful community reintegration and transition into civilian school settings. Symptom profiling may inform personalized cognitive interventions to enhance these students’ academic success.
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23
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Walter KH, Levine JA, Highfill-McRoy RM, Navarro M, Thomsen CJ. Prevalence of Posttraumatic Stress Disorder and Psychological Comorbidities Among U.S. Active Duty Service Members, 2006-2013. J Trauma Stress 2018; 31:837-844. [PMID: 30398680 DOI: 10.1002/jts.22337] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
Among active duty service members, posttraumatic stress disorder (PTSD) diagnoses have increased dramatically since 2000. Because psychiatric comorbidity is more common for PTSD than for other mental health disorders, we examined the prevalence estimates of disorders comorbid or trimorbid with PTSD in this study. The medical records of 523,626 female and male active duty Sailors and Marines who entered the U.S. military between 2006 and 2013 were examined for diagnoses of PTSD and 14 potentially comorbid disorders. Results showed that 1.8% of military members had a PTSD diagnosis; among those with PTSD, 83.3% had a comorbid mental health disorder, and 62.2% had a third (i.e., trimorbid) disorder. Most frequently, PTSD co-occurred with depressive disorder (49.0%), adjustment disorder (37.0%), generalized anxiety disorder (36.1%), and alcohol use disorder (26.9%). All disorders we examined were significantly more likely to be diagnosed in service members with PTSD than in those without PTSD, odds ratios = 1.52-29.63. For service members with PTSD, comorbid mental health disorders are the rule rather than the exception. Consequently, it is important that clinicians also assess for other disorders and select treatment options that address both PTSD and comorbid conditions.
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Affiliation(s)
- Kristen H Walter
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Jordan A Levine
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Robyn M Highfill-McRoy
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Melissa Navarro
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Cynthia J Thomsen
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
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24
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Cox M, Becker T, Motsumi M. Head trauma: A significant public health concern among young men in Botswana. Etiology referral patterns and opportunities for interventions. J Public Health Afr 2018; 9:798. [PMID: 30687477 PMCID: PMC6325414 DOI: 10.4081/jphia.2018.798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 02/26/2018] [Indexed: 11/23/2022] Open
Abstract
This study aims to present and discuss acute Head Injury (HI) presentations including etiology, referral patterns and disposition in patients presenting to a major referral hospital in Gaborone, Botswana. Cross-sectional, retrospective data collection from July 2015 through September 2015 extracted descriptions of patient demographics, mechanism of injury, comorbidities, diagnosis and disposition from Emergency Centre (EC) records. 360 HI patients presented in three months, averaging four per day and increasing on weekends and end of the month. HI disproportionately impacted young adult males, with motor vehicle accidents accounting for 38%, violence implicated in 39% and 80% recorded as blunt trauma. HIV status was unknown for 84% of patients at the time of presentation and 10% of patients were recorded as HIV positive. Patients referred from external hospitals had a higher admission rate. HI in young males is a significant trauma burden in this hospital, similar to the known regional trauma patterns. More studies regarding trauma, alcohol, and violence related to paydays should be considered to investigate and reduce the burden of HI in Botswana.
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Affiliation(s)
- Megan Cox
- Department of Emergency Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Timothy Becker
- Perelman School of Medicine, University of Pennsylvania, USA
| | - Mpapho Motsumi
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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25
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Williams WH, Chitsabesan P, Fazel S, McMillan T, Hughes N, Parsonage M, Tonks J. Traumatic brain injury: a potential cause of violent crime? Lancet Psychiatry 2018; 5:836-844. [PMID: 29496587 PMCID: PMC6171742 DOI: 10.1016/s2215-0366(18)30062-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/07/2017] [Accepted: 01/08/2018] [Indexed: 12/28/2022]
Abstract
Traumatic brain injury (TBI) is the biggest cause of death and disability in children and young people. TBI compromises important neurological functions for self-regulation and social behaviour and increases risk of behavioural disorder and psychiatric morbidity. Crime in young people is a major social issue. So-called early starters often continue for a lifetime. A substantial majority of young offenders are reconvicted soon after release. Multiple factors play a role in crime. We show how TBI is a risk factor for earlier, more violent, offending. TBI is linked to poor engagement in treatment, in-custody infractions, and reconviction. Schemes to assess and manage TBI are under development. These might improve engagement of offenders in forensic psychotherapeutic rehabilitation and reduce crime.
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Affiliation(s)
- W Huw Williams
- Department of Psychology, University of Exeter, Exeter, UK.
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Tom McMillan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nathan Hughes
- Sociological Studies, University of Sheffield, Sheffield, UK
| | | | - James Tonks
- Medical School, University of Exeter, Exeter, UK
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Kaimal G, Walker MS, Herres J, French LM, DeGraba TJ. Observational study of associations between visual imagery and measures of depression, anxiety and post-traumatic stress among active-duty military service members with traumatic brain injury at the Walter Reed National Military Medical Center. BMJ Open 2018; 8:e021448. [PMID: 29895656 PMCID: PMC6009636 DOI: 10.1136/bmjopen-2017-021448] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study aimed tocompare recurring themes in the artistic expression of military service members (SMs) with post-traumatic stress disorder (PTSD), traumatic brain injury and psychological health (PH) conditions with measurable psychiatric diagnoses. Affective symptoms and struggles related to verbally expressing information can limit communication in individuals with symptoms of PTSD and deployment-related health conditions. Visual self-expression through art therapy is an alternative way for SMs with PTSD and other PH conditions to communicate their lived experiences. This study offers the first systematic examination of the associations between visual self-expression and standardised clinical self-report measures. DESIGN Observational study of correlations between clinical symptoms of post-traumatic stress, depression and anxiety and visual themes in mask imagery. SETTING The National Intrepid Center of Excellence at the Walter Reed National Military Medical Center, Bethesda, Maryland, USA. PARTICIPANTS Active-duty military SMs (n=370) with a history of traumatic brain injury, post-traumatic stress symptoms and related PH conditions. INTERVENTION The masks used for analysis were created by the SMs during art therapy sessions in week 1 of a 4-week integrative treatment programme. PRIMARY OUTCOMES Associations between scores on the PTSD Checklist-Military, Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale on visual themes in depictions of aspects of individual identity (psychological injury, military symbols, military identity and visual metaphors). RESULTS Visual and clinical data comparisons indicate that SMs who depicted psychological injury had higher scores for post-traumatic stress and depression. The depiction of military unit identity, nature metaphors, sociocultural metaphors, and cultural and historical characters was associated with lower post-traumatic stress, depression and anxiety scores. Colour-related symbolism and fragmented military symbols were associated with higher anxiety, depression and post-traumatic stress scores. CONCLUSIONS Emergent patterns of resilience and risk embedded in the use of images created by the participants could provide valuable information for patients, clinicians and caregivers.
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Affiliation(s)
- Girija Kaimal
- Creative Arts Therapies, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA
| | - Melissa S Walker
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Joanna Herres
- Department of Psychology, The College of New Jersey, Stockton, New Jersey, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Thomas J DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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27
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Merritt VC, Clark AL, Sorg SF, Evangelista ND, Werhane M, Bondi MW, Schiehser DM, Delano-Wood L. Apolipoprotein E ε4 Genotype Is Associated with Elevated Psychiatric Distress in Veterans with a History of Mild to Moderate Traumatic Brain Injury. J Neurotrauma 2018; 35:2272-2282. [PMID: 29463164 DOI: 10.1089/neu.2017.5372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
As few studies have examined the relationship between the apolipoprotein E (APOE) gene and clinical outcomes after military-related traumatic brain injury (TBI), we aimed to determine whether the ε4 allele of the APOE gene influences neuropsychiatric symptoms in veterans with a history of mild-to-moderate TBI. Participants included 133 veterans (TBI = 79; military controls [MC] = 54) who underwent APOE genotyping and were divided into ε4+ (TBI = 18; MC = 15) and ε4- (TBI = 61; MC = 39) groups. All participants underwent evaluation of psychological distress using the Beck Depression Inventory-II, Beck Anxiety Inventory, and PTSD Checklist-Military Version. Two-way analyses of variance were conducted to examine the effect of group (TBI vs. MC) and APOE-ε4 status (ε4+ vs. ε4-) across symptom measures. There was a significant main effect of group across all symptom measures (TBI > MC; all p values <0.001), no main effect of ε4 genotype (p = 0.152-0.222), and a significant interaction of group by ε4 genotype across all measures (p = 0.027-0.047). Specifically, for TBI participants, ε4+ veterans demonstrated significantly higher symptom scores across all measures when compared to ε4- veterans (p = 0.007-0.015). For MC participants, ε4 status had no effect on the severity of psychiatric symptom scores (p = 0.585-0.708). Our results demonstrate that, in our well-characterized sample of veterans with history of neurotrauma, possession of the ε4 allele conveys risk for increased symptomatology (i.e., depression, anxiety, and post-traumatic stress disorder), even well outside of the acute phase of injury. Findings suggest a meaningful relationship between APOE genotype and psychiatric distress post-TBI, and they suggest that there is a brain basis for the complex neuropsychiatric presentation often observed in this vulnerable population. Future longitudinal studies are needed in order to further our understanding of how genetic factors influence response to TBI.
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Affiliation(s)
| | - Alexandra L Clark
- 2 San Diego State University/University of California , San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Scott F Sorg
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California
| | | | - Madeleine Werhane
- 2 San Diego State University/University of California , San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Mark W Bondi
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California
| | - Dawn M Schiehser
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California.,4 Center of Excellence for Stress and Mental Health , VASDHS, San Diego, California
| | - Lisa Delano-Wood
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California.,4 Center of Excellence for Stress and Mental Health , VASDHS, San Diego, California
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28
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Han K, Chapman SB, Krawczyk DC. Neuroplasticity of cognitive control networks following cognitive training for chronic traumatic brain injury. Neuroimage Clin 2018; 18:262-278. [PMID: 29876247 PMCID: PMC5987796 DOI: 10.1016/j.nicl.2018.01.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/19/2017] [Accepted: 01/24/2018] [Indexed: 12/14/2022]
Abstract
Cognitive control is the ability to coordinate thoughts and actions to achieve goals. Cognitive control impairments are one of the most persistent and devastating sequalae of traumatic brain injuries (TBI). There have been efforts to improve cognitive control in individuals with post-acute TBI. Several studies have reported changes in neuropsychological measures suggesting the efficacy of cognitive training in improving cognitive control. Yet, the neural substrates of improved cognitive control after training remains poorly understood. In the current study, we identified neural plasticity induced by cognitive control training for TBI using resting-state functional connectivity (rsFC). Fifty-six individuals with chronic mild TBI (9 years post-injury on average) were randomized into either a strategy-based cognitive training group (N = 26) or a knowledge-based training group (active control condition; N = 30) for 8 weeks. We acquired a total of 109 resting-state functional magnetic resonance imaging from 45 individuals before training, immediately post-training, and 3 months post-training. Relative to the controls, the strategy-based cognitive training group showed monotonic increases in connectivity in two cognitive control networks (i.e., cingulo-opercular and fronto-parietal networks) across time points in multiple brain regions (pvoxel < 0.001, pcluster < 0.05). Analyses of brain-behavior relationships revealed that fronto-parietal network connectivity over three time points within the strategy-based cognitive training group was positively associated with the trail making scores (pvoxel < 0.001, pcluster < 0.05). These findings suggest that training-induced neuroplasticity continues through chronic phases of TBI and that rsFC can serve as a neuroimaging biomarker of evaluating the efficacy of cognitive training for TBI.
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Affiliation(s)
- Kihwan Han
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA.
| | - Sandra B Chapman
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA.
| | - Daniel C Krawczyk
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Wagner AK. TBI Rehabilomics Research: an Exemplar of a Biomarker-Based Approach to Precision Care for Populations with Disability. Curr Neurol Neurosci Rep 2017; 17:84. [PMID: 28929311 DOI: 10.1007/s11910-017-0791-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize how "-omics" technologies can inform rehabilitation-relevant outcomes for a range of populations with neurologically related disability by including outcome metrics linked to the World Health Organization's International Classification of Functioning, Disability, and Health (WHO-ICF) domains of impairments in body function, activity limitations, and participation restrictions. RECENT FINDINGS To date, nearly every area of medicine uses biomarkers in some capacity to aid in understanding how personal biology informs clinical care. "-Omics"-based approaches use high throughput genomics, proteomics, and transcriptomics assay platforms to tailor and personalize treatments for subgroups of similar individuals based on these results. The recent Precision Medicine Initiative (PMI), sponsored by the National Institutes of Health (NIH), has propelled biomarker-based and genomics research to the forefront of many translational research and care programs addressing a variety of medical populations. Yet, the literature is sparse on precision medicine approaches for those with neurologically related and other disability. We demonstrate how the Rehabilomics Research model represents a translational framework for programs of precision rehabilitation research and care focused on linking personal biology to the biopsychosocial constructs that represent the WHO-ICF model and multidimensional outcome. We provide multiple exemplars from our own research program involving individuals with moderate-to-severe traumatic brain injury (TBI) to demonstrate how genomics and other biomarkers can be identified and assessed for their capacity to assist with personalized (precision) neurorehabilitation care and management.
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Affiliation(s)
- Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue Suite 202, Kaufman Building, Pittsburgh, PA, 15213, USA.
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30
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The chronic and evolving neurological consequences of traumatic brain injury. Lancet Neurol 2017; 16:813-825. [PMID: 28920887 DOI: 10.1016/s1474-4422(17)30279-x] [Citation(s) in RCA: 318] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) can have lifelong and dynamic effects on health and wellbeing. Research on the long-term consequences emphasises that, for many patients, TBI should be conceptualised as a chronic health condition. Evidence suggests that functional outcomes after TBI can show improvement or deterioration up to two decades after injury, and rates of all-cause mortality remain elevated for many years. Furthermore, TBI represents a risk factor for a variety of neurological illnesses, including epilepsy, stroke, and neurodegenerative disease. With respect to neurodegeneration after TBI, post-mortem studies on the long-term neuropathology after injury have identified complex persisting and evolving abnormalities best described as polypathology, which includes chronic traumatic encephalopathy. Despite growing awareness of the lifelong consequences of TBI, substantial gaps in research exist. Improvements are therefore needed in understanding chronic pathologies and their implications for survivors of TBI, which could inform long-term health management in this sizeable patient population.
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31
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Miles SR, Harik JM, Hundt NE, Mignogna J, Pastorek NJ, Thompson KE, Freshour JS, Yu HJ, Cully JA. Delivery of mental health treatment to combat veterans with psychiatric diagnoses and TBI histories. PLoS One 2017; 12:e0184265. [PMID: 28886114 PMCID: PMC5590892 DOI: 10.1371/journal.pone.0184265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/21/2017] [Indexed: 11/18/2022] Open
Abstract
Traumatic brain injury (TBI) and mental health (MH) disorders are prevalent in combat veterans returning from Afghanistan and/or Iraq (hereafter referred to as returning veterans). Accurate estimates of service utilization for veterans with and without TBI exposure (referred to as TBI history) are imperative in order to provide high quality healthcare to returning veterans. We examined associations between TBI history and MH service utilization in a subsample of returning veterans who were newly diagnosed with posttraumatic stress disorder (PTSD), depression, and/or anxiety in the 2010 fiscal year (N = 55,458). Data were extracted from the Veterans Health Administration (VHA) National Patient Care Database. Veterans with MH diagnoses and TBI histories attended significantly more psychotherapy visits, (M = 8.32 visits, SD = 17.15) and were more likely to attend at least 8 psychotherapy visits, (15.7%) than veterans with MH diagnoses but no TBI history (M = 6.48 visits, SD = 12.12; 10.1% attended at least 8 sessions). PTSD and TBI history, but not depression or anxiety, were associated with a greater number of psychotherapy visits when controlling for demographic and clinical variables. PTSD, anxiety, depression, and TBI history were associated with number of psychotropic medication-management visits. TBI history was related to greater MH service utilization, independent of MH diagnoses. Future research should examine what MH services are being utilized and if these services are helping veterans recover from their disorders.
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Affiliation(s)
- Shannon R. Miles
- Health Service Research and Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, Tampa, Florida, United States of America
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
- * E-mail:
| | - Juliette M. Harik
- National Center for PTSD-Executive Division, VA Medical Center (116D), White River Junction, Vermont, United States of America
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Natalie E. Hundt
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, MEDVAMC (152), Houston, Texas, United States of America
| | - Joseph Mignogna
- Center of Excellence for Research on Returning War Veterans, Waco, Texas, United States of America
- Central Texas Veterans Healthcare System, Waco, TX Texas A&M Health Science Center, Temple, Texas, United States of America
- Texas A&M Health Science Center, Temple, Texas, United States of America
| | - Nicholas J. Pastorek
- Rehabilitation and Extended Care Line, MEDVAMC, Houston, Texas, United States of America
| | - Karin E. Thompson
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
| | - Jessica S. Freshour
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
| | - Hong J. Yu
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
| | - Jeffrey A. Cully
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, MEDVAMC (152), Houston, Texas, United States of America
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32
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Haller CS. Twelve-month prospective cohort study of patients with severe traumatic brain injury and their relatives: Coping, satisfaction with life and neurological functioning. Brain Inj 2017; 31:1903-1909. [DOI: 10.1080/02699052.2017.1346295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Chiara S. Haller
- Department of Psychology, Harvard University, Cambridge, MA, USA; Division of Public Psychiatry, Massachusetts Mental Health Center, Boston, MA, USA
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33
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Schulz-Heik RJ, Poole JH, Dahdah MN, Sullivan C, Adamson MM, Date ES, Salerno R, Schwab K, Harris O. Service needs and barriers to care five or more years after moderate to severe TBI among Veterans. Brain Inj 2017; 31:1287-1293. [DOI: 10.1080/02699052.2017.1307449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- R. Jay Schulz-Heik
- Defense and Veterans Brain Injury Center, Palo Alto, CA and Rockville, MD, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - John H. Poole
- Defense and Veterans Brain Injury Center, Palo Alto, CA and Rockville, MD, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Marie N. Dahdah
- Baylor Institute for Rehabilitation, Dallas, TX, USA
- Baylor Regional Medical Center at Plano, Plano, TX, USA
| | - Campbell Sullivan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Maheen M. Adamson
- Defense and Veterans Brain Injury Center, Palo Alto, CA and Rockville, MD, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Rose Salerno
- Defense and Veterans Brain Injury Center, Palo Alto, CA and Rockville, MD, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Karen Schwab
- Defense and Veterans Brain Injury Center, Palo Alto, CA and Rockville, MD, USA
| | - Odette Harris
- Defense and Veterans Brain Injury Center, Palo Alto, CA and Rockville, MD, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
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34
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Fanning JR, Keedy S, Berman ME, Lee R, Coccaro EF. Neural Correlates of Aggressive Behavior in Real Time: a Review of fMRI Studies of Laboratory Reactive Aggression. Curr Behav Neurosci Rep 2017; 4:138-150. [PMID: 29607288 PMCID: PMC5875983 DOI: 10.1007/s40473-017-0115-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Aggressive behavior has adaptive value in many natural environments; however, it places substantial burden and costs on human society. For this reason, there has long been interest in understanding the neurobiological basis of aggression. This interest, and the flourishing of neuroimaging research in general, has spurred the development of a large and growing scientific literature on the topic. As a result, a neural circuit model of aggressive behavior has emerged that implicates interconnected brain regions that are involved in emotional reactivity, emotion regulation, and cognitive control. RECENT FINDINGS Recently, behavioral paradigms that simulate provocative interactions have been adapted to neuroimaging protocols, providing an opportunity to directly probe the involvement of neural circuits in an aggressive interaction. Here we review neuroimaging studies of simulated aggressive interactions in research volunteers. We focus on studies that use a well-validated laboratory paradigm for reactive physical aggression and examine the neural correlates of provocation, retaliation, and evaluating punishment of an opponent. SUMMARY Overall, the studies reviewed support the involvement of neural circuits that support emotional reactivity, emotion regulation, and cognitive control in aggressive behavior. Based on a synthesis of this literature, future research directions are discussed.
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Affiliation(s)
- Jennifer R Fanning
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Sarah Keedy
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Mitchell E Berman
- Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA
| | - Royce Lee
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Emil F Coccaro
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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35
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The Prevalence of Traumatic Brain Injury Among People With Co-Occurring Mental Health and Substance Use Disorders. J Head Trauma Rehabil 2017; 32:E65-E74. [DOI: 10.1097/htr.0000000000000249] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2016; 33:1969-1994. [PMID: 26729611 DOI: 10.1089/neu.2015.4252] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review examined pre- and post-injury prevalence of, and risk factors for, anxiety disorders and depressive disorders after traumatic brain injury (TBI), based on evidence from structured diagnostic interviews. A systematic literature search was conducted in EMBASE, MEDLINE, Cochrane Central, PubMed, PsycINFO, and Google Scholar. We identified studies in civilian adults with TBI reporting on the prevalence of anxiety and depressive disorders using structured diagnostic interviews and assessed their quality. Pooled pre- and post-injury prevalence estimates of anxiety disorders and depressive disorders were computed. A total of 34 studies described in 68 publications were identified, often assessing anxiety disorders (n = 9), depressive disorders (n = 7), or a combination of disorders (n = 6). Prevalence rates of psychiatric disorders varied widely. Pooled prevalence estimates of anxiety and depressive disorders were 19% and 13% before TBI and 21% and 17% in the first year after TBI. Pooled prevalence estimates increased over time and indicated high long-term prevalence of Axis I disorders (54%), including anxiety disorders (36%) or depressive disorders (43%). Females, those without employment, and those with a psychiatric history before TBI were at higher risk for anxiety and depressive disorders after TBI. We conclude that a substantial number of patients encounter anxiety and depressive disorders after TBI, and that these problems persist over time. All health care settings should pay attention to the occurrence of psychiatric symptoms in the aftermath of TBI to enable early identification and treatment of these disorders and to enhance the recovery and quality of life of TBI survivors.
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Affiliation(s)
- Annemieke C Scholten
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Juanita A Haagsma
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Maryse C Cnossen
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Miranda Olff
- 2 Department of Psychiatry, Center for Psychological Trauma, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Ed F van Beeck
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Suzanne Polinder
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
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37
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Kim SW, Putzke M, Uhl E, Krishnan KG. Self-Inflicted Hammer Blows to the Cranial Vault: An Interdisciplinary Challenge. Prim Care Companion CNS Disord 2016; 18:15br01927. [PMID: 27722022 DOI: 10.4088/pcc.15br01927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/26/2016] [Indexed: 10/21/2022] Open
Abstract
Depression is predicted to be the most common cause of disability in the coming decade. Self-inflicted hammer blow to the cranium is a rare phenomenon seen in patients with a history of attempted suicide. The resulting comminuted depressed skull fracture of the midline vertex is life threatening. Rapid interdisciplinary communication and intervention are essential to reduce morbidity and mortality. We present a case of self-inflicted hammer blows to the head, review the relevant literature on this topic, and discuss neurosurgical and psychiatric implications.
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Affiliation(s)
- Seong Woong Kim
- Department of Neurosurgery, Justus Liebig University Giessen, Germany
| | - Michael Putzke
- Department of Psychiatry and Psychotherapy, Friedberg Hospital, Friedberg, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus Liebig University Giessen, Germany
| | - Kartik G Krishnan
- Department of Neurosurgery, Justus Liebig University Giessen, Germany
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38
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Walker MS, Kaimal G, Koffman R, DeGraba TJ. Art therapy for PTSD and TBI: A senior active duty military service member’s therapeutic journey. ARTS IN PSYCHOTHERAPY 2016. [DOI: 10.1016/j.aip.2016.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Zaninotto AL, Vicentini JE, Fregni F, Rodrigues PA, Botelho C, de Lucia MCS, Paiva WS. Updates and Current Perspectives of Psychiatric Assessments after Traumatic Brain Injury: A Systematic Review. Front Psychiatry 2016; 7:95. [PMID: 27378949 PMCID: PMC4906018 DOI: 10.3389/fpsyt.2016.00095] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/19/2016] [Indexed: 01/06/2023] Open
Abstract
Neuropsychological and psychiatric disorders represent a major concern and cause of disabilities after the trauma, contributing to worse recovery after traumatic brain injury (TBI). However, the lack of well-defined parameters to evaluate patient's psychiatric disorders leads to a wide range of diagnoses and symptoms. The aim of this study was to perform a review of literature in order to gather data of the most common scales and inventories used to assess and diagnose depression, anxiety, and posttraumatic stress disorder (PTSD) after TBI. We conducted a literature search via MEDLINE, PubMed, and Web of Science. We included reviews, systematic reviews, and meta-analysis studies, and we used the following keywords: "traumatic brain injury OR TBI," "depression OR depressive disorder," "anxiety," and "posttraumatic stress disorder OR PTSD." From 610 titles, a total of 68 systematic reviews or meta-analysis were included in the section "Results" of this review: depression (n = 32), anxiety (n = 9), and PTSD (n = 27). Depression after TBI is a more established condition, with more homogeneous studies. Anxiety and PTSD disorders have been studied in a heterogeneous way, usually as comorbidity with other psychiatric disorders. Some scales and inventories designed for the general community may not be appropriate for patients with TBI.
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Affiliation(s)
- Ana Luiza Zaninotto
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | - Jessica Elias Vicentini
- Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
| | | | - Cibele Botelho
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | | | - Wellingson Silva Paiva
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
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Tweedie D, Fukui K, Li Y, Yu QS, Barak S, Tamargo IA, Rubovitch V, Holloway HW, Lehrmann E, Wood WH, Zhang Y, Becker KG, Perez E, Van Praag H, Luo Y, Hoffer BJ, Becker RE, Pick CG, Greig NH. Cognitive Impairments Induced by Concussive Mild Traumatic Brain Injury in Mouse Are Ameliorated by Treatment with Phenserine via Multiple Non-Cholinergic and Cholinergic Mechanisms. PLoS One 2016; 11:e0156493. [PMID: 27254111 PMCID: PMC4890804 DOI: 10.1371/journal.pone.0156493] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/16/2016] [Indexed: 11/18/2022] Open
Abstract
Traumatic brain injury (TBI), often caused by a concussive impact to the head, affects an estimated 1.7 million Americans annually. With no approved drugs, its pharmacological treatment represents a significant and currently unmet medical need. In our prior development of the anti-cholinesterase compound phenserine for the treatment of neurodegenerative disorders, we recognized that it also possesses non-cholinergic actions with clinical potential. Here, we demonstrate neuroprotective actions of phenserine in neuronal cultures challenged with oxidative stress and glutamate excitotoxicity, two insults of relevance to TBI. These actions translated into amelioration of spatial and visual memory impairments in a mouse model of closed head mild TBI (mTBI) two days following cessation of clinically translatable dosing with phenserine (2.5 and 5.0 mg/kg BID x 5 days initiated post mTBI) in the absence of anti-cholinesterase activity. mTBI elevated levels of thiobarbituric acid reactive substances (TBARS), a marker of oxidative stress. Phenserine counteracted this by augmenting homeostatic mechanisms to mitigate oxidative stress, including superoxide dismutase [SOD] 1 and 2, and glutathione peroxidase [GPx], the activity and protein levels of which were measured by specific assays. Microarray analysis of hippocampal gene expression established that large numbers of genes were exclusively regulated by each individual treatment with a substantial number of them co-regulated between groups. Molecular pathways associated with lipid peroxidation were found to be regulated by mTBI, and treatment of mTBI animals with phenserine effectively reversed injury-induced regulations in the ‘Blalock Alzheimer’s Disease Up’ pathway. Together these data suggest that multiple phenserine-associated actions underpin this compound’s ability to ameliorate cognitive deficits caused by mTBI, and support the further evaluation of the compound as a therapeutic for TBI.
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Affiliation(s)
- David Tweedie
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Koji Fukui
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
- Division of Bioscience and Engineering, Shibaura Institute of Technology, Saitama 3378570, Japan
| | - Yazhou Li
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Qian-sheng Yu
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Shani Barak
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, 69978 Israel
| | - Ian A. Tamargo
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Vardit Rubovitch
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, 69978 Israel
| | - Harold W. Holloway
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Elin Lehrmann
- Laboratory of Genetics and Genomics, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - William H. Wood
- Laboratory of Genetics and Genomics, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Yongqing Zhang
- Laboratory of Genetics and Genomics, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Kevin G. Becker
- Laboratory of Genetics and Genomics, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Evelyn Perez
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Henriette Van Praag
- Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
| | - Yu Luo
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Barry J. Hoffer
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Robert E. Becker
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
- Independent Researcher, 7123 Pinebrook Road, Park City, UT 94098, United States of America
| | - Chaim G. Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, 69978 Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, 69978 Israel
| | - Nigel H. Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States of America
- * E-mail:
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Myrga JM, Juengst SB, Failla MD, Conley YP, Arenth PM, Grace AA, Wagner AK. COMT and ANKK1 Genetics Interact With Depression to Influence Behavior Following Severe TBI: An Initial Assessment. Neurorehabil Neural Repair 2016; 30:920-930. [PMID: 27154305 DOI: 10.1177/1545968316648409] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Genetic variations in the dopamine (DA) system are associated with cortical-striatal behavior in multiple populations. This study assessed associations of functional polymorphisms in the ankyrin repeat and kinase domain (ANKK1; Taq1a) and catechol-O-methyltransferase (COMT; Val158Met) genes with behavioral dysfunction following traumatic brain injury (TBI). PARTICIPANTS This was a prospective study of 90 survivors of severe TBI recruited from a level 1 trauma center. MAIN MEASURES The Frontal Systems Behavior Scale, a self- or family report questionnaire evaluating behavior associated with frontal lobe dysfunction, was completed 6 and 12 months postinjury. Depression was measured concurrently with the Patient Health Questionnaire-9. Study participants were genotyped for Val158Met and Taq1a polymorphisms. RESULTS No statistically significant behavioral differences were observed by Taq1a or Val158Met genotype alone. At 12 months, among those with depression, Met homozygotes (Val158Met) self-reported worse behavior than Val carriers (P = .015), and A2 homozygotes (Taq1a) self-reported worse behavior than A1 carriers (P = .028) in bivariable analysis. Multivariable models suggest an interaction between depression and genetic variation with behavior at 12 months post-TBI, and descriptive analysis suggests that carriage of both risk alleles may contribute to worse behavioral performance than carriage of either risk allele alone. CONCLUSION In the context of depression, Val158Met and Taq1a polymorphisms are individually associated with behavioral dysfunction 12 months following severe TBI, with preliminary evidence suggesting cumulative, or perhaps epistatic, effects of COMT and ANKK1 on behavioral dysfunction.
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Affiliation(s)
- John M Myrga
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | | | - Yvette P Conley
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Patricia M Arenth
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Anthony A Grace
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA Department of Neuroscience, University of Pittsburgh, Pittsburgh PA Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA
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Fishbein D, Dariotis JK, Ferguson PL, Pickelsimer EE. Relationships Between Traumatic Brain Injury and Illicit Drug Use and Their Association With Aggression in Inmates. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2016; 60:575-597. [PMID: 25326469 DOI: 10.1177/0306624x14554778] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Extensive interviews of correctional inmates in South Carolina (2009-2010) were conducted under a Center for Disease Control and Prevention (CDC) grant. We evaluated the extent to which early traumatic brain injury (TBI) and subsequent illicit drug abuse may conjointly influence development of aggression, controlling for alcohol use, and whether cognitive or emotional dysregulation mediated this relationship. Early TBI predicted greater severity and earlier onset of drug use, and an earlier age at first use predicted greater aggression regardless of the age of TBI. Emotional dysregulation mediated effects of TBI on aggression. The potential to design more targeted treatments for this susceptible population are discussed.
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Affiliation(s)
- Diana Fishbein
- University of Maryland School of Medicine, Ellicott City, MD, USA
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Mills AL, Kreutzer JS. Theoretical Applications of Positive Psychology to Vocational Rehabilitation After Traumatic Brain Injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:20-31. [PMID: 26373862 DOI: 10.1007/s10926-015-9608-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Traumatic brain injury (TBI) produces broad-reaching and often persistent challenges that impact an individual’s ability to engage in vocational productivity. Return to work (RTW) rates after TBI are markedly poor and the efficacy of current TBI vocational rehabilitation (VR) practices is unclear. Positive psychology, the practice of fostering positive emotions and traits, offers novel approaches that might enhance the effectiveness of existing TBI VR practices. This article assesses the potential relevance of positive psychology principles and practices to VR for clients recovering from TBI. METHODS A literature search was conducted using the database resources of a large university hospital, including PubMed, ProQuest, PsycINFO, and Web of Science. Content from this search was reviewed and synthesized, including literature on VR for TBI, vocational applications of positive psychology, and general rehabilitation applications of positive psychology. RESULTS Ten guiding principles for positively-informed TBI VR are proposed. Specific positive psychology measures and interventions for improving emotional, social, and cognitive functioning are identified and discussed as they might be applied to TBI VR. CONCLUSIONS Theoretically, positive psychology principles and practices appear to be well suited to improving VR outcomes for individuals with TBI. In addition to examining the feasibility of incorporating positive psychology techniques, future research should examine the impact of positive psychology interventions on RTW rates, job satisfaction, job stability, and other vocational outcomes. With additional investigation, positive psychology measures and interventions may prove to be a beneficial compliment to existing VR practices.
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Affiliation(s)
- Ana L Mills
- Department of Physical Medicine and Rehabilitation, VCU Medical Center, Virginia Commonwealth University, P.O. Box 980542, Richmond, VA, 23298-0542, USA.
| | - Jeffrey S Kreutzer
- Department of Physical Medicine and Rehabilitation, VCU Medical Center, Virginia Commonwealth University, P.O. Box 980542, Richmond, VA, 23298-0542, USA
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
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Schulz-Heik RJ, Poole JH, Dahdah MN, Sullivan C, Date ES, Salerno RM, Schwab K, Harris O. Long-term outcomes after moderate-to-severe traumatic brain injury among military veterans: Successes and challenges. Brain Inj 2016; 30:271-9. [PMID: 26853377 DOI: 10.3109/02699052.2015.1113567] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess long-term outcomes after traumatic brain injury (TBI) among veterans and service members. SETTING Regional Veterans Affairs medical centre. PARTICIPANTS One hundred and eighteen veterans and military personnel, aged 23-70 years (median = 35 years), 90% male, had moderate-to-severe TBI (82% in coma > 1 day, 85% amnesic > 7 days), followed by acute interdisciplinary rehabilitation 5-16 years ago (median = 8 years). DESIGN Cross-sectional analysis of live interviews conducted via telephone. MAIN MEASURES TBI follow-up interview (occupational, social, cognitive, neurologic and psychiatric ratings), Community Integration Questionnaire, Disability Rating Scale (four indices of independent function) and Satisfaction with Life Scale. RESULTS At follow-up, 52% of participants were working or attending school; 34% ended or began marriages after TBI, but the overall proportion married changed little. Finally, 22% were still moderately-to-severely disabled. However, 62% of participants judged themselves to be as satisfied or more satisfied with life than before injury. Injury severity, especially post-traumatic amnesia, was correlated with poorer outcomes in all functional domains. CONCLUSIONS After moderate-severe TBI, most veterans assume productive roles and are satisfied with life. However, widespread difficulties and functional limitations persist. These findings suggest that veteran and military healthcare systems should continue periodic, comprehensive follow-up evaluations long after moderate-to-severe TBI.
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Affiliation(s)
| | - John H Poole
- a Defence and Veterans Brain Injury Center , Palo Alto , CA , USA
| | - Marie N Dahdah
- b Baylor Regional Medical Center at Plano, Baylor Institute for Rehabilitation , Plano , TX , USA
| | | | | | - Rose M Salerno
- a Defence and Veterans Brain Injury Center , Palo Alto , CA , USA
| | - Karen Schwab
- e Defense and Veterans Brain Injury Center , Rockville , MD , USA
| | - Odette Harris
- a Defence and Veterans Brain Injury Center , Palo Alto , CA , USA
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Stéfan A, Mathé JF. What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices. Ann Phys Rehabil Med 2016; 59:5-17. [DOI: 10.1016/j.rehab.2015.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022]
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Comparison of cognitive behavioral therapy and supportive psychotherapy for the treatment of depression following traumatic brain injury: a randomized controlled trial. J Head Trauma Rehabil 2015; 29:467-78. [PMID: 25370439 DOI: 10.1097/htr.0000000000000098] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the efficacy of 2 different interventions (cognitive behavioral therapy [CBT] and supportive psychotherapy [SPT]) to treat post-traumatic brain injury (TBI) depression. PARTICIPANTS A sample of 77 community-dwelling individuals with a TBI, and a diagnosis of depression. Participants were randomized into treatment conditions either CBT or SPT and received up to 16 sessions of individual psychotherapy. MEASURES Participants completed the Structured Clinical Interview for DSM-IV and self-report measures of depression (Beck Depression Inventory-Second Edition), anxiety (State-Trait Anxiety Inventory), perceived social support (Interpersonal Support Evaluation List), stressful life events (Life Experiences Survey), and quality of life (QOL) before beginning and immediately following treatment. RESULTS No significant differences were found at baseline between CBT and SPT groups on demographic factors (sex, age, education, race, and time since injury) or baseline measures of depression, anxiety, participation, perceived social support, stressful life events, or QOL. Analyses of variance revealed significant time effects for the Beck Depression Inventory-Second Edition, State-Trait Anxiety Inventory, and QOL outcome measures but no group effects. Intention-to-treat mixed effects analyses did not find any significant difference in patterns of scores of the outcome measures between the CBT and SPT intervention groups. CONCLUSIONS Both forms of psychotherapy were efficacious in improving diagnoses of depression and anxiety and reducing depressive symptoms. These findings suggest that in this sample of individuals with TBI, CBT was not more effective in treating depression than SPT, though further research is needed with larger sample sizes to identify different components of these interventions that may be effective with different TBI populations. ClinicalTrials.gov Identifier: NCT00211835.
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Resilience Following Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study. Arch Phys Med Rehabil 2015; 97:708-13. [PMID: 26707459 DOI: 10.1016/j.apmr.2015.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine resilience at 3 months after traumatic brain injury (TBI). DESIGN Cross-sectional analysis of an ongoing observational cohort. SETTING Five inpatient rehabilitation centers, with 3-month follow-up conducted primarily by telephone. PARTICIPANTS Persons with TBI (N=160) enrolled in the resilience module of the TBI Model System study with 3-month follow-up completed. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Connor-Davidson Resilience Scale. RESULTS Resilience scores were lower than those of the general population. A multivariable regression model, adjusting for other predictors, showed that higher education, absence of preinjury substance abuse, and less anxiety at follow-up were significantly related to greater resilience. CONCLUSIONS Analysis suggests that lack of resilience may be an issue for some individuals after moderate to severe TBI. Identifying persons most likely at risk for low resilience may be useful in planning clinical interventions.
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Zhu Y, Jin W, Liu H, Peng D, Ding Z, Tang Z, Zhu L, Yu Y. Effects of electromagnetic fields from mobile phones on depression and anxiety after titanium mesh cranioplasty among patients with traumatic brain injury. Brain Inj 2015; 30:66-73. [PMID: 26595678 DOI: 10.3109/02699052.2015.1089594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the effects of radiofrequency-electromagnetic fields (RF-EMFs) from mobile phones on depression and anxiety after titanium mesh cranioplasty among patients with traumatic brain injury (TBI). METHODS Two hundred and twenty patients with TBI and titanium mesh cranioplasty who were hospitalized from 2008-2012 were recruited in this study. From November-December 2012, the relevant information was surveyed including socio-demographic characteristics, lifestyle variables, injury-related information, RF-EMF exposure of mobile phone, Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS). Associations of RF-EMFs exposure after titanium mesh cranioplasty with SAS and SDS were respectively estimated by multivariable linear regression models. RESULTS The patients with long durations of mobile phone use (β = -6.6, p = 0.002), long individual call duration (β = -5.3, p = 0.012), more daily calls (β = -3.6, p = 0.027), invariably answer call immediately (β = -3.9, p = 0.022) and high comprehensive exposure level (β = -4.8, p = 0.003) had a lower score of depression compared with those without a mobile phone. Moreover, an ipsilateral and contralateral answering phone enhanced the protective effect on depression. Individuals with a long duration of mobile phone use had a lower score of anxiety (β = -4.2, p = 0.008), while those with a bilateral answering phone had higher anxiety (β = 3.9, p = 0.012) in comparison to those without a mobile phone. CONCLUSION RF-EMFs after cranioplasty were significantly associated with the lower risk of depression and anxiety status among patients with TBI. Chronic and frequent RF-EMFs exposure may improve psychiatric disorders among patients with TBI.
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Affiliation(s)
- Yongjian Zhu
- a Department of Neurosurgery , Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , Zhejiang , P.R. China
| | - Wen Jin
- b Department of Epidemiology & Health Statistics , Zhejiang University , Hangzhou , Zhejiang , P.R. China , and.,c Chronic Disease Research Institute, School of Public Health, School of Medicine , Zhejiang University , Hangzhou , Zhejiang , P.R. China
| | - Hui Liu
- b Department of Epidemiology & Health Statistics , Zhejiang University , Hangzhou , Zhejiang , P.R. China , and.,c Chronic Disease Research Institute, School of Public Health, School of Medicine , Zhejiang University , Hangzhou , Zhejiang , P.R. China
| | - Deqing Peng
- a Department of Neurosurgery , Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , Zhejiang , P.R. China
| | - Zheyuan Ding
- b Department of Epidemiology & Health Statistics , Zhejiang University , Hangzhou , Zhejiang , P.R. China , and.,c Chronic Disease Research Institute, School of Public Health, School of Medicine , Zhejiang University , Hangzhou , Zhejiang , P.R. China
| | - Zhuxiao Tang
- a Department of Neurosurgery , Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , Zhejiang , P.R. China
| | - Liangliang Zhu
- a Department of Neurosurgery , Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , Zhejiang , P.R. China
| | - Yunxian Yu
- b Department of Epidemiology & Health Statistics , Zhejiang University , Hangzhou , Zhejiang , P.R. China , and.,c Chronic Disease Research Institute, School of Public Health, School of Medicine , Zhejiang University , Hangzhou , Zhejiang , P.R. China
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Life after Adolescent and Adult Moderate and Severe Traumatic Brain Injury: Self-Reported Executive, Emotional, and Behavioural Function 2-5 Years after Injury. Behav Neurol 2015; 2015:329241. [PMID: 26549936 PMCID: PMC4621342 DOI: 10.1155/2015/329241] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/01/2015] [Indexed: 12/16/2022] Open
Abstract
Survivors of moderate-severe Traumatic Brain Injury (TBI) are at risk for long-term cognitive, emotional, and behavioural problems. This prospective cohort study investigated self-reported executive, emotional, and behavioural problems in the late chronic phase of moderate and severe TBI, if demographic characteristics (i.e., age, years of education), injury characteristics (Glasgow Coma Scale score, MRI findings such as traumatic axonal injury (TAI), or duration of posttraumatic amnesia), symptoms of depression, or neuropsychological variables in the first year after injury predicted long-term self-reported function. Self-reported executive, emotional, and behavioural functioning were assessed among individuals with moderate and severe TBI (N = 67, age range 15–65 years at time of injury) 2–5 years after TBI, compared to a healthy matched control group (N = 72). Results revealed significantly more attentional, emotional regulation, and psychological difficulties in the TBI group than controls. Demographic and early clinical variables were associated with poorer cognitive and emotional outcome. Fewer years of education and depressive symptoms predicted greater executive dysfunction. Younger age at injury predicted more aggressive and rule-breaking behaviour. TAI and depressive symptoms predicted Internalizing problems and greater executive dysfunction. In conclusion, age, education, TAI, and depression appear to elevate risk for poor long-term outcome, emphasising the need for long-term follow-up of patients presenting with risk factors.
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Relationship Between Resilience, Adjustment, and Psychological Functioning After Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:241-8. [DOI: 10.1097/htr.0000000000000137] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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