Biomedical subjects

Mary R Hibbard

Publications and source records attributed to Mary R Hibbard.

8 recordsLinked to original sources

PubMed2006

Traumatic brain injury in the elderly: diagnostic and treatment challenges.

The purpose of this review is to introduce geriatric practitioners to issues and challenges presented in the elderly after onset of traumatic brain injury (TBI). Issues discussed include the magnitude of TBI in the elderly, mechanisms of onset, issues specific to both acute and rehabilitation care for the elderly with TBI, and specific physical and behavioral manifestations of TBI that may need to be addressed on an inpatient or outpatient basis. General guidelines are provided for the diagnosis and treatment of older individuals who have TBI, with specific clinical scenarios illustrating key points.

Acute Disease↗

PubMed2006

Neurobehavioral consequences of traumatic brain injury.

At least 1.4 million people die, or receive hospital or emergency care every year in the United States as a result of traumatic brain injury (TBI). Many more are treated in other settings or receive no treatment at all. Thus TBI is often unidentified, with subsequent cognitive, behavioral, emotional and physical sequelae that are not linked to the injury. Yet, over 5.3 million Americans live with TBI-related disabilities that interfere with their overall performance and social roles within the community. The pathophysiology and consequences of TBI are discussed, as are functional changes and psychiatric manifestations after TBI. Finally, implications and recommendations for clinical practice are reviewed, including the importance of screening for TBI.

Brain Injuries↗

PubMed2005

The impact of age on traumatic brain injury.

Older individuals with TBI differ from younger adults with TBI in several ways, including their incidence rates, etiology of injury, nature of complications, lengths of hospitalization, functional outcomes, and mortality. Despite the greater likelihood of poorer functional outcomes, older adults with TBI often achieve good functional outcomes and can live in community settings after receiving appropriate rehabilitation services, although at higher costs and longer hospitalizations than younger individuals. The future of rehabilitation care for elderly patients after TBI is uncertain due to financial limitations associated with the implementation of the PPS payment system by CMS. Little is known regarding the long-term impact of TBI on individuals as they age, but this is an important issue as the population ages.

Age Factors↗

PubMed2004

Relationship between depression and psychosocial functioning after traumatic brain injury.

OBJECTIVE: To examine the relationship between depression and psychosocial functioning up to 5 years after traumatic brain injury (TBI). DESIGN: Longitudinal cohort study with 2 assessments completed. SETTING: Community. PARTICIPANTS: Individuals (N=188) with TBI living in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Structured Clinical Interview for Depression, self-reports of depression severity, functional symptoms, quality of life (QOL), unmet important needs, and psychosocial functioning. RESULTS: Based on observed depression patterns at initial and repeat assessment, 4 subgroups were created: no depression, resolved depression, late-onset depression, and chronic depression. Groups were equivalent in terms of demographic and injury-related factors but differed significantly in perceived psychosocial functioning. The no-depression group reported fewer depressive symptoms and higher levels of psychosocial functioning, whereas the chronic-depression group reported the poorest psychosocial functioning, with a further decline in QOL at reassessment. Although the resolved-depression and late-onset-depression groups reported similar psychosocial functioning at initial assessment, psychosocial functioning had improved for the resolved-depression group and declined for the late-onset-depression group at reassessment. Pre- and postpsychiatric diagnoses were common in all groups, with pre-TBI diagnosis of depression not predictive of post-TBI depression. CONCLUSIONS: Findings highlight the need for broad-based assessments and timely interventions for both mood and psychosocial challenges after TBI.

Adult↗

PubMed2004

Psychiatric challenges in the first 6 years after traumatic brain injury: cross-sequential analyses of Axis I disorders.

OBJECTIVE: To examine the preinjury rates of Axis I disorders and the prospective rates within the first 6 years after traumatic brain injury (TBI). DESIGN: Cross-sectional, longitudinal, and cross-sequential. SETTING: Community-based research and training center. PARTICIPANTS: Persons (N=188) who had sustained TBI within 4 years of enrollment into the project were interviewed at either 2 and 3 assessments. Each assessment was approximately 1 year apart. Several Axis I diagnoses were analyzed to detect cross-sectional differences (by age and time postinjury) and average individual changes over the multiple measurement time points. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. RESULTS: The odds ratios changed longitudinally within each subject, indicating a decreased probability of having an Axis I diagnosis over time. There were few cross-sectional differences in age; therefore, age at the time of injury had little impact on Axis I diagnoses. Cross-sectional time since injury was not associated with more psychiatric disorders, whereas cross-sectional preinjury history of psychiatric disorders was predictive of postinjury psychiatric disorders. After controlling for cross-sectional effects, the frequencies of Axis I disorders increased in depression, anxiety, and posttraumatic stress disorders in the first assessment postinjury and declined in subsequent assessments. CONCLUSIONS: Cross-sequential analyses that control for cross-sectional and longitudinal differences produced a more complete description of psychiatric disorders after TBI.

Adult↗

PubMed2004

Screening for substance abuse in individuals with traumatic brain injury.

PRIMARY OBJECTIVE: To determine the utility of the CAGE, the Brief Michigan Alcohol Screening Test (BMAST) and the Substance Abuse Subtle Screening Inventory (SASSI-3) with individuals with traumatic brain injury (TBI), two studies were conducted examining the accuracy, sensitivity and specificity of these instruments. RESEARCH DESIGN: Data from self-report instruments were compared to a clinical interview, Structured Clinical Interview for DSM-IV (SCID), to determine the accuracy, sensitivity and specificity. METHODS AND PROCEDURES: Two studies were conducted. In study I, 100 individuals with TBI were screened for alcohol abuse using the CAGE and the resulting classifications were compared with those derived from the SCID. In study II, 223 individuals were screened for alcohol abuse and drug abuse using the BMAST and SASSI-3 and the results of these screenings were compared with diagnoses obtained by the SCID. MAIN OUTCOMES AND RESULTS: The specificity of the self-report instruments was moderately high, ranging between 81-83%. The specificity of the CAGE for alcohol abuse both pre- and post-TBI was high, 96% and 86%, respectively. The sensitivity of the self-report instruments was most variable, ranging from 32-95%, with the SASSI face valid drug scale and the CAGE alcohol post-TBI indicating the most sensitivity, 95 and 91%, respectively. CONCLUSIONS: The findings suggest that the CAGE may be useful in screening for alcohol abuse and the face valid drug sub-scale of the SASSI-3 may be useful in screening for drug abuse in individuals with TBI.

Adolescent↗

PubMed2002

Peer support in the community: initial findings of a mentoring program for individuals with traumatic brain injury and their families.

OBJECTIVES: To evaluate the impact of a community-based peer support program for individuals and their family members following traumatic brain injury (TBI). SETTINGS: Community-based sample of family members and individuals with traumatic brain injury. PARTICIPANTS: Twenty individuals who had participated in the peer support program (11 individuals with TBI and 9 family members). MAIN OUTCOME MEASURES: Quantitative and qualitative approaches were used: a retrospective structured interview assessing self-reported impacts of peer support on empowerment, quality of life, mood, skills and knowledge, and social supports; an in-depth qualitative interview with a subgroup of family members focused on the specific benefits/limitations of the peer support program. RESULTS: Participants in the peer support program reported positive impacts of peer support on increasing their knowledge of TBI, enhancing their overall quality of life, improving their general outlook, and enhancing their ability to cope with depression post TBI. The peer support program was reported to have had a minimal impact on enhancing social support from families, friends, and the community, with varying impacts noted on levels of happiness, coping with anger and anxiety, communication with professionals, and control over one's life. Qualitative analysis suggests the merits of this type of community-based support and areas of improvement for the peer support program itself. CONCLUSIONS: Preliminary data suggest that peer support is a promising approach to enhancing coping for both individuals and their family members after TBI.

Adolescent↗

PubMedDate not supplied

The role of self-discrepancy theory in understanding post-traumatic brain injury affective disorders: a pilot study.

This pilot study examined the utility of self-discrepancy theory (SDT) in explaining post-traumatic brain injury (TBI) depression and anxiety. The SDT model was expanded to include the discrepancy between the postinjury self and the preinjury self. Study participants were 21 individuals with mild to severe TBI residing in the community, who completed the Selves Interview, the Selves Adjective Checklist, the Beck Depression Inventory-II and the Beck Anxiety Inventory. Strong correlations were found between affective distress and self-discrepancies, as measured by the checklist. Scores on the interview were not related to affective distress. The findings suggest that further research is merited to examine the utility of the SDT in addressing issues of post-TBI depression and anxiety.

Adaptation, Psychological↗