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Fraser EE, Downing MG, Haines K, Bennett L, Olver J, Ponsford JL. Experience of adapted cognitive behaviour therapy to address sexuality problems after traumatic brain injury: A qualitative study. Neuropsychol Rehabil 2024; 34:572-599. [PMID: 37306485 DOI: 10.1080/09602011.2023.2221858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
Although sexuality has been shown to be negatively impacted in up to half of individuals who sustain traumatic brain injury (TBI), few studies have sought to evaluate the efficacy of targeted interventions. Gaining insight into the participant experience of undergoing treatment for post-TBI sexuality changes is a crucial aspect of intervention evaluation. This study aimed to investigate participants with TBI experience of undergoing eight sessions of a novel CBT intervention designed to help both couples and singles improve sexual wellbeing after TBI. Eight participants (50% male) with moderate-severe TBI, and a mean age of 46.38-years (SD = 13.54), completed a qualitative interview. A six-phase reflexive thematic analysis approach was used. Despite variability in participant characteristics, the findings suggested that participants with TBI experience reflected that of a positive treatment journey characterized by high levels of enjoyment and satisfaction. Key themes identified included contextual factors that preceded treatment, factors that facilitated treatment engagement, outcomes derived from the treatment experience, and feedback provided on reflection. The results not only provide an enriched understanding of the client experience of the intervention but provide corroborating preliminary evidence of efficacy for this novel CBT intervention in addressing complex and persistent sexuality problems after TBI.
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Affiliation(s)
- Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Epworth Healthcare, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Epworth Healthcare, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Kerrie Haines
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Linda Bennett
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - John Olver
- Epworth HealthCare, Rehabilitation Medicine, Richmond, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Epworth Healthcare, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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Arango-Lasprilla JC, Watson JD, Rodríguez MJ, Ramos-Usuga D, Perrin PB. Patterns of Alcohol Use in Hispanic Individuals with TBI over the Ten Years Post-Injury: A Model Systems Study. J Pers Med 2024; 14:105. [PMID: 38248806 PMCID: PMC10817313 DOI: 10.3390/jpm14010105] [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: 11/30/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
The study's aim was to examine alcohol consumption patterns and predictors of consumption across time among Hispanics with traumatic brain injury (TBI) in the U.S. within ten years post-injury. This longitudinal cohort study included 1342 Hispanic individuals (77.6% males) from the multi-site, longitudinal TBI Model Systems (TBIMS) database. The main outcome measures were consumption information, demographic, and injury characteristics. Across the full sample, alcohol consumption variables generally demonstrated quadratic movement characterized by an initial increase followed by a plateau or slight decrease over the ten years post-injury. The predictors of higher consumption were being men, single, with a history of excessive alcohol use, with a nonviolent mechanism of injury, shorter duration of PTA, and higher levels of education. Participants had a greater number of 5+ drinks/episode occurrences in the past month if they were men and had had a greater number of 5+ drinks/episode occurrences in the month before injury. There was no differential change in alcohol consumption over time as a function of these predictors. This study identified a profile of at-risk Hispanics with TBI for increased alcohol consumption. These individuals should be identified and targeted for early evidence-based alcohol intervention after TBI when results might be most favorable.
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Affiliation(s)
| | - Jack D. Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Miriam J. Rodríguez
- School of Public Health, Department of Health and Wellness Design, Indiana University, Bloomington, IN 47408, USA;
| | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain;
| | - Paul B. Perrin
- School of Data Science, Department of Psychology, University of Virginia, Charlottesville, VA 22904, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. METHODS An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. RESULTS Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. CONCLUSIONS An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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Fraser EE, Downing MG, Haines K, Bennett L, Olver J, Ponsford JL. Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines. J Clin Med 2022; 11:jcm11123525. [PMID: 35743597 PMCID: PMC9225377 DOI: 10.3390/jcm11123525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted.
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Affiliation(s)
- Elinor E. Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, VIC 3121, Australia
- Correspondence:
| | - Marina G. Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, VIC 3121, Australia
| | - Kerrie Haines
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
| | - Linda Bennett
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
| | - John Olver
- Rehabilitation Medicine, Epworth HealthCare, Richmond, VIC 3121, Australia;
| | - Jennie L. Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, VIC 3121, Australia
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Kohnen RF, Lavrijsen J, Akkermans R, Gerritsen D, Koopmans R. The prevalence and determinants of inappropriate sexual behaviour in people with acquired brain injury in nursing homes. J Adv Nurs 2021; 77:3058-3072. [PMID: 33634494 PMCID: PMC8248184 DOI: 10.1111/jan.14817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
AIMS Establishing the prevalence of inappropriate sexual behaviour, concurrent challenging behaviours and the determinants of inappropriate sexual behaviour among patients with acquired brain injury ≤65 years of age in Dutch nursing homes. DESIGN Cross-sectional, observational study in acquired brain injury special care units spreads throughout the country. METHODS Nursing homes were recruited through the national expertise network for patients with severe acquired brain injury, regional brain injury teams and by searching the Internet. Patient characteristics were collected through digital questionnaires. Inappropriate sexual behaviour was assessed with the St. Andrews Sexual Behaviour Assessment, concurrent challenging behaviours with the NeuroPsychiatric Inventory-Nursing Home Version and the Cohen-Mansfield Agitation Inventory, cognition with the Mini-Mental State Examination and activities of daily living with the Disability Rating Scale. Psychotropic drug use was retrieved from the electronic prescription system. Associations between determinants and inappropriate sexual behaviour were examined using multilevel multivariate linear regression model analyses. Data collection started in June 2017 and ended in April 2019. RESULTS Of the 118 included patients, 38.1% had one or more inappropriate sexual behaviours. Verbal comments (30.1%) and non-contact behaviour (24.8%) were the most prevalent types of inappropriate sexual behaviour. Less severe behaviours were more common than more severe behaviours. The most frequent concurrent challenging behaviours were agitation, aggression and hyperactivity. Physical aggression was associated with more inappropriate sexual behaviour. Being married and pain were associated with less inappropriate sexual behaviour. CONCLUSION Inappropriate sexual behaviour is prevalent in patients with acquired brain injury ≤65 years of age residing in nursing homes. IMPACT Inappropriate sexual behaviour may have impact not only on the patients themselves but also on nursing staff. Insight into the magnitude, severity, course and concurrent challenging behaviours, sexuality and quality of life could give direction to the kind of interventions and education that is needed. The ultimate goal is to develop appropriate care for this vulnerable group of patients, specifically psychosocial interventions and appropriate use of psychotropic drugs.
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Affiliation(s)
- Roy F. Kohnen
- Vivent, Rosmalen and LivioEnschedethe Netherlands
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Jan Lavrijsen
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Reinier Akkermans
- Radboud University Medical CenterRadboud Institute for Health SciencesScientific Institute for Quality of CareNijmegenthe Netherlands
| | - Debby Gerritsen
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Raymond Koopmans
- Department of Primary and Community CareRadboud University Medical CenterDe Waalboog“Joachim and Anna”Centre for Specialized Geriatric CareNijmegenthe Netherlands
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Anto-Ocrah M, Oktapodas Feiler M, Pukall C, Pacos-Martinez A. Resilience and Sexuality After Concussion in Women. Sex Med 2021; 9:100297. [PMID: 33482610 PMCID: PMC7930863 DOI: 10.1016/j.esxm.2020.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Previous findings from our group show that in the acute (ie, 6–10 weeks) post-injury period, women with concussions have a 70% greater risk of sexual dysfunction than those with extremity injuries. There are currently limited treatment options for the clinical management of concussions. Resilience is a protective, modifiable psychological construct that has been shown to improve concussion-related sequelae. To date, however, no research has evaluated how resilience impacts sexuality outcomes after concussion in women. Aim Evaluate if resilience offers protection against negative sexuality outcomes in a cohort of reproductive, aged women with a concussion, seeking care in the Emergency Department of a Level-1 Trauma Center. We hypothesized that women with low resilience will be more likely to experience negative impacts on sexuality and that increasing levels of resilience will be associated with more positive sexuality outcomes. Methods Secondary data analyses. Measures Resilience was evaluated with the Resilience Scale (RS), and the Brain Injury Questionnaire for Sexuality (BIQS) was used for sexuality. Results Of the 299 participants recruited for the parent study, 80 with concussion had complete follow-up data and were included in these secondary analyses. Less than half (42.5%; n = 34) had low resilience (score≤130 on the RS), and the remaining 46 (57.5%) had high resilience (score>130 on the RS). In crude linear regression models, 1-unit increase in resilience was associated with a 4% increase in sexuality outcomes (β = 0.04, 95% CI:0.01, 0.05; P = .008). The effect estimate remained similar in post-concussion-symptom-adjusted models (β = 0.03, 95% CI:0.002, 0.06; P = .03). Mood-adjusted models showed a statistically significant interaction term (P < .0001). After stratifying by mood, findings showed that unit increases in resilience were associated with a 6% increase in sexuality outcomes for women in the high risk mood group (HADS score ≥11; PCS-adjusted β = 0.06, 95% CI:0.02, 0.11; P = .009). Conclusion Longitudinal studies are needed to evaluate how these improvements in resilience translate to patient recovery measures following concussion. Anto-Ocrah M, Oktapodas Feiler M, Pukall C, et al. Resilience and Sexuality After Concussion in Women. Sex Med 2021;9:100297.
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Affiliation(s)
- Martina Anto-Ocrah
- Department of Emergency Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY; Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY; Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY.
| | - Marina Oktapodas Feiler
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | - Caroline Pukall
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Amy Pacos-Martinez
- Department of Physical Medicine & Rehabilitation, School of Medicine and Dentistry, University of Rochester, Rochester, NY
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Briken P. An integrated model to assess and treat compulsive sexual behaviour disorder. Nat Rev Urol 2020; 17:391-406. [DOI: 10.1038/s41585-020-0343-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
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Karabatzakis M, Den Oudsten BL, Gosens T, De Vries J. Psychometric properties of the psychosocial screening instrument for physical trauma patients (PSIT). Health Qual Life Outcomes 2019; 17:172. [PMID: 31718663 PMCID: PMC6852899 DOI: 10.1186/s12955-019-1234-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023] Open
Abstract
Background Early detection of psychosocial problems post-injury may prevent them from becoming chronic. Currently, there is no psychosocial screening instrument that can be used in patients surviving a physical trauma or injury. Therefore, we recently developed a psychosocial screening instrument for adult physical trauma patients, the PSIT. The aim of this study was to finalize and psychometrically examine the PSIT. Methods All adult (≥ 18 years) trauma patients admitted to a Dutch level I trauma center from October 2016 through September 2017 without severe cognitive disorders (n = 1448) received the PSIT, Impact of Events Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Rosenberg Self-Esteem Scale (RSES), State-Trait Anxiety Inventory-State (STAI-S), and the World Health Organization Quality of Life-Abbreviated version (WHOQOL-Bref). After 2 weeks, a subgroup of responding participants received the PSIT a second time. The internal structure (principal components analysis, PCA; and confirmatory factor analysis, CFA), internal consistency (Cronbach’s alpha, α), test-retest reliability (Intraclass Correlation Coefficient, ICC), construct validity (Spearman’s rho correlations), diagnostic accuracy (Area Under the Curve, AUC), and potential cut-off values (sensitivity and specificity) were examined. Results A total of 364 (25.1%) patients participated, of whom 128 completed the PSIT again after 19.5 ± 6.8 days. Test-retest reliability was good (ICC = 0.86). Based on PCA, five items were removed because of cross-loadings ≥ 0.3. Three subscales were identified: (1) Negative affect (7 items; α = 0.91; AUC = 0.92); (2) Anxiety and Post-Traumatic Stress Symptoms (4 items; α = 0.77; AUC = 0.88); and (3) Social and self-image (4 items; α = 0.79; AUC = 0.92). CFA supported this structure (comparative fit index = 0.96; root mean square error of approximation = 0.06; standardized rood mean square residual = 0.04). Four of the five a priori formulated hypotheses regarding construct validity were confirmed. The following cut-off values represent maximum sensitivity and specificity: 7 on subscale 1 (89.6% and 83.4%), 3 on subscale 2 (94.4% and 90.3%), and 4 on subscale 3 (85.7% and 90.7%). Conclusion The final PSIT has good psychometric properties in adult trauma patients.
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Affiliation(s)
- Maria Karabatzakis
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Brenda Leontine Den Oudsten
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Taco Gosens
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands.,Department of Orthopaedics and Traumatology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands. .,Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. .,Department of Medical Psychology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
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Anto-Ocrah M, Bazarian J, Lewis V, Jones CM, Jusko TA, Van Wijngaarden E. Risk of female sexual dysfunction following concussion in women of reproductive age. Brain Inj 2019; 33:1449-1459. [PMID: 31322004 DOI: 10.1080/02699052.2019.1644377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Traumatic Brain Injury (TBI) has frequently been associated with changes in sexual functioning. The TBI and sexuality literature, however, has limited generalizability to concussed females, who often use the emergency department (ED) as their first line of care after head injury. Primary Objective: The primary objective of this study was to evaluate the impact of concussions on female sexual functioning. Secondary Objective: Secondarily, we evaluated if concussed women with sexual dysfunction also report more post-concussion symptoms (PCS) and/or mood changes. Research Design: This was a prospective cohort, with outcomes assessed at 6-10 weeks after ED enrollment. Methods and Procedures: Sexual dysfunction was defined as ≤ 45 on the Brain Injury Questionnaire on Sexuality (BIQS). The Rivermead Post-concussion Symptoms Questionnaire (RPQ) and the Hospital Anxiety and Depression Scale (HADS) assessed PCS and post-injury mood, respectively. Main Outcomes & Results: Eighty-nine eumenorrheic females (8-14 menstrual cycles/year) completed the study; 31(36%) had concussions, and 55(64%) were extremity injured. Concussed women had 70% increased risk of sexual dysfunction (adj.RR:1.70, 95% CI: 1.04,2.76; p = .03) versus extremity injured. Of clinical relevance, concussed women with sexual dysfunction also reported more PCS symptoms (adj.β = 5.5, 95% CI: -6.7,18.2; p = .37) and mood scores (adj.β = 8.0; 95% CI: -0.4, 16.4; p = .06). Conclusions: This study highlights the need for more research and interventions for one of the fastest growing subgroups within the TBI population.
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Affiliation(s)
- Martina Anto-Ocrah
- a Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,b Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,c Department of Neurology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Jeff Bazarian
- a Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,c Department of Neurology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Vivian Lewis
- b Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Courtney Marie Jones
- a Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Todd A Jusko
- d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Edwin Van Wijngaarden
- d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
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Changes in Caregivers Lifestyle after Severe Acquired Brain Injury: A Preliminary Investigation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2824081. [PMID: 30065934 PMCID: PMC6051321 DOI: 10.1155/2018/2824081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/07/2018] [Accepted: 06/10/2018] [Indexed: 11/18/2022]
Abstract
Introduction Severe acquired brain injury (sABI) is considered the most common cause of death and disability worldwide. sABI patients are supported by their caregivers who often exhibit high rates of psychological distress, mood disorders, and changes in relationship dynamics and family roles. Objectives To explore lifestyle changes of caregivers of sABI patients during the postacute rehabilitation, by investigating possible differences between primary and secondary caregivers. Primary caregivers spend most of the time with the patient, providing daily care and taking most responsibility for the day-to-day decisions, while secondary caregivers are those who provide additional support. Methods Three hundred forty-seven caregivers of sABI patients were asked to fill in an unpublished self-report questionnaire to explore their possible lifestyles changes. Results A statistically significant difference was found between primary and secondary caregivers in time spent in informal caregiving (p<0.001). The primary caregivers reduced all leisure activities compared to secondary carers (p<0.05). Conclusions By comparing the percentage of leisure activities performed by caregivers before and after the patient's sABI onset, all caregivers showed high percentages of changes in lifestyle and habits, even though primary caregivers reported more negative lifestyle changes than secondary caregivers. Further studies are needed to investigate needs and burden experienced by caregivers of sABI patients during the postacute rehabilitation phase, also in relation to the patients' outcome, to address support interventions for them and improve their quality of life.
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Yang YJ, Chien WC, Chung CH, Hong KT, Yu YL, Hueng DY, Chen YH, Ma HI, Chang HA, Kao YC, Yeh HW, Tzeng NS. Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan. Am J Mens Health 2018; 12:913-925. [PMID: 29325484 PMCID: PMC6131467 DOI: 10.1177/1557988317750970] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction: In our study, we aimed to investigate the association between a traumatic
brain injury (TBI) and subsequent erectile dysfunction (ED). This is a
population-based study using the claims dataset from The National Health
Insurance Research Database. Methods: We included 72,642 patients with TBI aged over 20 years, retrospectively,
selected from the longitudinal health insurance database during 2000–2010,
according to the ICD-9-CM. The control group consisted of 217,872 patients
without TBI that were randomly chosen from the database at a ratio of 1:3,
with age- and index year matched. Cox proportional hazards analysis was used
to estimate the association between the TBI and subsequent ED. Results: After a 10-year follow-up, the incidence rate of ED was higher in the TBI
patients when compared with the non-TBI control group (24.66 and 19.07 per
100,000, respectively). Patients with TBI had a higher risk of developing ED
than the non-TBI cohort after the adjustment of the confounding factors,
such as age, comorbidity, residence of urbanization and locations, seasons,
level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95%
CI [1.890, 3.492], p < .001). Conclusion: This is the first study using a comprehensive nationwide database to analyze
the association of ED and TBI in the Asian population. After adjusted the
confounding factors, patients with TBI have a significantly higher risk of
developing ED, especially organic ED, than the general population. This
finding might remind clinicians that it’s crucial in early identification
and treatment of ED in post-TBI patients.
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Affiliation(s)
- Yun-Ju Yang
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- 2 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- 2 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,4 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Kun-Ting Hong
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Lin Yu
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Dueng-Yuan Hueng
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yuan-Hao Chen
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-I Ma
- 1 Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-An Chang
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,6 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Chen Kao
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,7 Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hui-Wen Yeh
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,8 Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, ROC.,9 Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.,10 Department of Nursing, Kang Ning University (Taipei Campus), Taipei, Taiwan, ROC
| | - Nian-Sheng Tzeng
- 5 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,6 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
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Abstract
PURPOSE OF REVIEW To provide an overview of post-The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. classifications related to human sexuality. After reviewing the literature on classification and clinical practice of sexual disorders, some of the most important contributions on main sexological classifications and frameworks were selected, especially from January 2016 till June 2017. RECENT FINDINGS New relevant contributions on psychiatric and sexological classifications and frameworks have been proposed, such as the international classification of diseases 11th revision (ICD-11), research domain criteria, the third edition of the Diagnostic Manual in Sexology and the person-centered psychiatry perspective. SUMMARY ICD-11 proposals regarding conditions related to sexual health including sexual dysfunctions and gender incongruence as well as vaginismus, such as sexual pain disorder, paraphilic disorders as mental Disorders. The disorders associated with sexual development and orientation, are proposed for deletion. The other perspectives aforementioned are also presented.
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