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Biomedical subjects

J R Fann

Publications and source records attributed to J R Fann.

8 recordsLinked to original sources
PubMed2002

Psychiatric illness and subsequent traumatic brain injury: a case control study.

OBJECTIVE: To determine whether psychiatric illness is a risk factor for subsequent traumatic brain injury (TBI). METHODS: Case control study in a large staff model health maintenance organisation in western Washington State. Patients with TBI, determined by International classification of diseases, 9th revision, clinical modification (ICD-9-CM) diagnoses, were 1440 health plan members who had TBI diagnosed in 1993 and who had been enrolled in the previous year, during which no TBI was ascertained. Three health plan members were randomly selected as control subjects, matched by age, sex, and reference date. Psychiatric illness in the year before the TBI reference date was determined by using computerised records of ICD-9-CM diagnoses, psychiatric medication prescriptions, and utilisation of a psychiatric service. RESULTS: For those with a psychiatric diagnosis in the year before the reference date, the adjusted relative risk for TBI was 1.7 (95% confidence interval (CI) 1.4 to 2.0) compared with those without a psychiatric diagnosis. Patients who had filled a psychiatric medication prescription had an adjusted relative risk for TBI of 1.6 (95% CI 1.2 to 2.1) compared with those who had not filled a psychiatric medication prescription. Patients who had utilised psychiatric services had an adjusted relative risk for TBI of 1.3 (95% CI 1.0 to 1.6) compared with those who had not utilised psychiatric services. The adjusted relative risk for TBI for patients with psychiatric illness determined by any of the three psychiatric indicators was 1.6 (95% CI 1.4 to 1.9) compared with those without any psychiatric indicator. CONCLUSION: Psychiatric illness appears to be associated with an increased risk for TBI.

Adolescent↗
PubMed2000

Physical activity and subarachnoid haemorrhage: a population based case-control study.

OBJECTIVE: To evaluate physical activity as a risk factor for subarachnoid haemorrhage. METHODS: A population based case-control study in King County, Washington. A standardised, personal interview was used to determine physical activity during the past year and at the onset of the bleed for case patients and a similar reference time for control subjects. Conditional logistic regression and a case cross over analysis were performed in which each case patient served as his or her own control. Subjects were 149 men and women with incident, spontaneous subarachnoid haemorrhage and two control subjects per case patient. Control subjects were identified through random digit dialing and matched on age, sex, and respondent type. RESULTS: Four of the 149 (2.7%) case patients were engaged in vigorous physical activity at the time of their subarachnoid haemorrhage. With those who were engaged in non-vigorous or no physical activity serving as the reference group, the relative risk of sustaining a subarachnoid haemorrhage for those engaged in vigorous physical activity was 11.6 (95% confidence interval (95% CI) 1.2-113.2). In the case cross over analysis, the relative risk was 15.0 (95% CI 4.3-52.2). Higher levels of long term regular physical activity over the past year were associated with a lower, but not statistically significant, risk of subarachnoid haemorrhage (test for trend, p=0.3). CONCLUSION: The risk of subarachnoid haemorrhage is increased during vigorous physical activity, although only a few result from this mechanism.

Adult↗
PubMed2000

Sertraline in the treatment of major depression following mild traumatic brain injury.

An 8-week, nonrandomized, single-blind, placebo run-in trial of sertraline was conducted on 15 patients diagnosed with major depression between 3 and 24 months after a mild traumatic brain injury. On the Hamilton Rating Scale for Depression, 13 (87%) had a decrease in score of > or = 50% ("response"), and 10 (67%) achieved a score of < or = 7 ("remission") by week 8 of sertraline. There was statistically significant improvement in psychological distress, anger and aggression, functioning, and postconcussive symptoms with treatment.

Adult↗
PubMed2000

The epidemiology of delirium: a review of studies and methodological issues.

Information about the epidemiology of delirium has grown tremendously over the past 2 decades. However, methodological challenges have made this area of research difficult to study. Most studies have focused on the prevalence, risk factors, and course of delirium in elderly populations and acute medical and surgical settings. Growing evidence is showing that delirium is a neuropsychiatric syndrome that deserves more research and clinical attention. This article summarizes the current literature on the epidemiology of delirium and discusses some of the important methodological issues in conducting and interpreting research in this area.

Cross-Sectional Studies↗
PubMed1995

Psychiatric disorders and functional disability in outpatients with traumatic brain injuries.

OBJECTIVE: This study examined psychiatric sequelae of traumatic brain injuries in outpatients and their relation to functional disability. METHOD: Fifty consecutive outpatients with traumatic brain injuries who came to a brain injury rehabilitation clinic for initial evaluation were examined for DSM-III-R diagnoses with the use of the National Institute of Mental Health Diagnostic Interview Schedule. The patients completed the Medical Outcomes Study Health Survey to assess functional disability and a questionnaire to assess postconcussion symptoms and self-perceptions of the severity of their brain injuries and cognitive functioning. RESULTS: Thirteen (26%) of the patients had current major depression, and an additional 14 (28%) reported a first-onset major depressive episode after the injury that had resolved. Twelve (24%) had current generalized anxiety disorder, and four (8%) reported current substance abuse. The group with depression and/or anxiety was significantly more impaired than the nondepressed/nonanxious patients according to the Medical Outcomes Study Health Survey measures of emotional role functioning, mental health, and general health perceptions. The depressed/anxious group also rated their injuries as significantly more severe and their cognitive functioning as significantly worse, despite the lack of significant differences in objective measures of severity of injury and Mini-Mental State examination scores. The depressed patients reported significantly more postconcussion symptoms that were increasing in severity over time. CONCLUSIONS: Depression and anxiety are common in outpatients with traumatic brain injuries. Patients with depression or anxiety are more functionally disabled and perceive their injury and cognitive impairment as more severe. Depressed patients report more increasingly severe postconcussion symptoms.

Adult↗
PubMed1994

Postconcussional disorder: time to acknowledge a common source of neurobehavioral morbidity.

Closed head injuries are common, affecting approximately 2 million people annually in the United States. The majority of these are "mild" in the sense of not being associated with prolonged unconsciousness, intracranial bleeding, skull fracture, or protracted periods of confusion. Yet a proportion of such "mild" injuries are accompanied by persisting cognitive, vegetative, and affective-behavioral sequelae, some of which affect day-to-day life. We argue that there is sufficient research to indicate that postconcussional symptoms occur and that they tend to have a predictable configuration. It is necessary to recognize the existence of "Postconcussional Disorder" in our nosology in order to provide more prompt diagnosis and management and to facilitate scholarly communication and research regarding this important neurobehavioral disorder.

Cognition Disorders↗
PubMedDate not supplied

Cognitive improvement with treatment of depression following mild traumatic brain injury.

The authors examined the effect of antidepressant treatment on cognitive performances in people with mild traumatic brain injury. An 8-week nonrandomized, single-blind, placebo run-in trial of sertraline was completed and neuropsychological testing measures were compared before and after the treatment trial. Results showed improvements in psychomotor speed, recent verbal memory, recent visual memory, and general cognitive efficiency. Improvements were also seen in self-perception of cognitive symptomatology. It appears that successful depression treatment resulted in significant alleviation of cognitive impairments, which may not have been accounted for by natural recovery alone.

Adult↗