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PubMedDate not supplied

Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury.

Post-concussional symptoms, such as headache, dizziness and irritability, are thought to result from the emotional stress associated with decreased cognitive performance after a head injury. A questionnaire-based investigation was carried out in 71 patients with mild head injury (MHI), using a heterogeneous item pool in order to study the interrelationships between traditional post-concussive complaints, cognitive problems, and more emotional and functional complaints. Factor analysis indicated that post-concussive symptoms loaded together with items on problems associated with decreased work performance and fatigability on a first factor, whereas psychovegetative and emotional complaints loaded together on a second factor. Two rating scales were constructed from the relevant items and were used to compare between subgroups of MHI patients and non-concussed controls. Patients with uncomplicated MHI had significantly higher scores than non-concussed subjects on the post-concussive-cognitive scale, but not on the emotional-vegetative scale. Patients with multiple head injuries or pre-existing emotional problems had higher scores on both the post-concussive-cognitive scale and the emotional-vegetative scale than MHI patients without a history of emotional problems. Reliable rating scales may be useful in multidiagnostic studies of MHI patients.

Adult↗

PubMed2001

A unique panic-disorder presentation among Khmer refugees: the sore-neck syndrome.

This article describes a previously unreported cultural syndrome among Khmer refugees. This common presentation of distress centers on the complaint of a sore neck, the sufferer fearing that wind-and-blood pressure may burst the vessels in this area. During an acute episode, a Khmer endures many--if not all--of the following neck-and-head complaints: headache, blurry vision, a buzzing in the ear, and dizziness. While in the throes of the sore-neck attack, the patient frequently experiences palpitations as well as other symptoms of autonomic arousal, such as diaphoresis, shortness of breath, and trembling. A sufferer of sore-neck episodes often meets panic disorder criteria. In a clinic survey, thirty-five out of eighty-five patients (41%) were found to currently suffer the "sore-neck syndrome" (i.e., to have endured at least one episode in the last month), with almost all of these thirty-five patients (80%) fearing death during the acute event. The sore-neck syndrome represents a common and important way in which distress becomes embodied. The clinician must learn this body language; otherwise, the patient's communication of psychic, interpersonal, and physical pain goes unheard--and grave somatic suffering and disability unattended to--discounted as puzzling somatic complaints and unreasonable obsessionalism about blood pressure.

Adult↗

PubMed2025

Shared genetic risk and causal associations between Post-traumatic stress disorder and migraine with antithrombotic agents and other medications.

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that frequently co-occurs with pain disorders including migraine. There are proposed biological, genetic and environmental factors associated with both PTSD and migraine suggesting shared etiology. Genome-Wide Association Studies (GWAS) have been used to identify genomic risk loci associated with various disorders and to investigate genetic overlap between traits. There is a significant genetic correlation between PTSD and migraine with no evidence of a causal relationship that could be attributed to pleiotropy. Cross-disorder genetic analyses were applied to investigate the genetic overlap and causal associations using GWAS summary statistics of PTSD (n = 214408), migraine (n = 873341) and 23 medication use traits (n = 78808-305913) including anti-depressants, anti-migraine preparations and beta-blocking agents. Across the entire genome, anti-thrombotic agents had a significant and negative genetic correlation with PTSD (rG = -0.2, P FDR = 0.032) and a positive genetic correlation with migraine (rG = 0.26, P FDR = 2.23 x 10-8). PTSD showed significant genetic correlation with 11 other medication use traits including beta blocking agents (rG = -0.11, P FDR = 0.034). Of the 2495 genomic regions tested, PTSD showed significant local genetic correlation with 12 medication use traits at 43 loci; while migraine showed significant genetic correlation with only anti-inflammatory agents and anti-rheumatic products at locus 12:57522282-57607142 (DAB1) (P < 2 x 10-5). The genetic liability to PTSD had a causal effect on increased risk of using pain medication such as opioids (β ivw = 0.59, P = 5.21 x 10-5) while the genetic liability to migraine had a causal effect on the increased risk of using anti-thrombotic agents (β ivw = 0.59, P = 1.69 x 10-7). The genes in the genomic regions shared between PTSD and medication use traits were enriched in neural-related pathways such as neuron development, neurogenesis and protein kinase activity. These results provide further insight into the genetically controlled biological and environmental factors underlying the shared etiology between PTSD and migraine. The identified biomarkers can be used as a basis for investigation as potential drug targets for both disorders. These findings are significant for drug re-purposing and treatment of PTSD and migraine using monotherapy.

GWAS↗

PubMed1999

Critical incident stress debriefing (CISD) in a shipping company.

Critical incident stress debriefing (CISD) is a method used successfully to reduce suffering from stress-related ailments such as insomnia, depression, anger, headaches etc. The resources of the shipping company are very limited and, thus, networking with existing organizations and specialists is necessary to carry out CISD effectively. The present company model has been adopted to take into account various situations and levels of disaster. The model has been adopted at three levels of events:Level 1. Serious accidents on shore, sudden deaths, severe events and threats. Events involving one or only few persons. Level 2. Life-threatening occupational accidents on board ship, suicide of a workmate, sudden death and fire on board ship. Events involving one person or limited group of persons. Level 3. Disasters at sea. Severe events involving all or nearly all persons on board ship. Actions at different levels: Level 1: A leaflet describing CISD, situations where it would be appropriate and where it is available, is given to each sailor. The victim is encouraged to seek CISD from public health care centres, most of which have their own services in Finland. Level 2. Training of about 8 hours is carried out by an experienced crisis psychologist for supervisors and officers on board ship. After the training they are able to identify stressful situations. At each harbour, the shipping company has made agreements with experienced crisis psychologists to act as specialists and contact persons on shore. These nominated psychologists will initiate CISD actions when necessary. If they need extra manpower they will turn to other psychologists. Level 3. In such serious accidents, the company's own resources alone are insufficient to provide effective CISD. All available public and private resources will he needed (health care organizations, Red Cross, Church etc.).

Crisis Intervention↗

PubMed2005

Violence exposure and traumatic stress symptoms as additional predictors of health problems in high-risk children.

OBJECTIVE: To test the hypotheses that both violence and traumatic stress symptoms are associated with negative health status among poor preschool children. STUDY DESIGN: This cross-sectional analysis of a Head Start preschool age cohort (n = 160) studied health outcomes parallel to those assessed in the 2001 National Health Interview Survey of child health (asthma, allergy, attention deficit hyperactivity disorder, global appraisal) as well as two stress-related somatic complaints, gastrointestinal problems and headache. Risk factors include sociodemographics, mothers' health factors, extent of exposure to violence and maltreatment, and mother- and teacher-reported traumatic stress symptoms. RESULTS: Compared with poor children in the National Health Interview Survey and their Head Start peers, children exposed to violence and those with high levels of traumatic stress had significantly worse outcomes, in a dose-response relation. Being abused, exposed to domestic violence, and having a mother using substances were associated with a higher number of health problems. The hierarchical model established the mother's own poor physical health and the child's level of traumatic stress as the strongest predictors of poor child health. CONCLUSIONS: These two risk factors are amenable to intervention by health care providers who treat children.

Adult↗

PubMedDate not supplied

Psychiatric morbidity following motor vehicle accidents: a review of methodological issues.

Motor vehicle accidents (MVAs), even those of a nonserious nature, appear to increase the risk of severe psychiatric morbidity in survivors. The present review examines the evidence indicating the levels of psychiatric morbidity in MVA survivors. Although no consistent profile has emerged, the most commonly reported symptoms are depression, anxiety, irritability, driving phobia, anger, sleep disturbances, and headache, with rates of posttraumatic stress disorder (PTSD) across studies of 0% to 100%. Variability in the type and severity of psychiatric outcomes may be due, in part, to methodological inadequacies in many studies, particularly the use of biased population samples, inclusion of subjects exposed to varied types of accidents, an absence of a clear definition of PTSD, a reliance on clinical judgment rather than the use of objective psychometric measures, the failure to include ratings of injury severity, and the absence of assessments for past exposure to traumatic events or preexisting posttraumatic reactions. The most important concern relates to the use of nonrepresentative samples, usually patients referred for medicolegal assessment in whom issues of compensation are of central importance. Gender and age differences distinguish the compensation group from the general population of MVA survivors, who therefore may also differ in the vulnerability to posttraumatic morbidity. It is argued that more systematic research on unselected subject samples is critical to establish epidemiological data on the true nature and extent of psychiatric morbidity following MVAs.

Accidents, Traffic↗

PubMed2001

Diagnostic criteria and differential diagnosis of mild traumatic brain injury.

Brain injury is classified clinically as severe, moderate or mild brain injury characteristics, including admission Glasgow coma score, duration of unconsciousness and post-traumatic amnesia and any focal neurological findings. Most traumatic brain injuries are classified as mild traumatic brain injury (MTBI). Headache, nausea and dizziness are frequent symptoms after MTBI and may continue for weeks to months after the trauma. MTBI may also be complicated by intracranial injuries. Experimental animal models and post-mortem studies have shown axonal damage and dysfunction in MTBI. This damage is mostly localized in the frontal lobes. Serum S-100 and NSE have been reported to be markers for the seventy of brain damage. In the literature, indications for radiodiagnostic evaluation following MTBI have been the subject of debate. Radiographs of the skull are used to exclude skull fractures, but are not useful for an evaluation of brain injury. Computed tomography of the brain seems to be the best way to exclude the development of relevant intracranial lesions. MTBI has a good clinical outcome, although a substantial group of patients develop post-concussional complaints (PCC). There is little information on the effectiveness of various methods suggested for reducing the frequency of PCC.

Brain Injuries↗

PubMed1991

Posttraumatic stress disorder, depression, and somatic symptoms in U.S. Mien patients.

This report describes treatment over a period of 6 years of Mien refugees from highland Laos in the Indochinese Psychiatric Program of the Oregon Health Sciences University (Portland, OR). The medical and psychiatric problems of 84 patients were presented through somatic symptoms such as headache, dizziness, or musculoskeletal pain. Primary care medical problems were identified and treated, with the major focus on the two most common psychiatric diagnoses: major depression and posttraumatic stress disorder. Cultural beliefs about illness and medication interfered with adherence to prescribed treatment. A marked sensitivity to side effects of certain antidepressants also resulted in subtherapeutic doses. Patients rarely volunteered their traumatic histories, psychiatric problems, or dissatisfaction with medications. However, the effective use of medication for somatic complaints, along with the continuing recognition of Mien health beliefs in psychosocial treatments, allowed for the development of a trusting doctor-patient relationship and continued psychiatric care.

Adolescent↗

PubMedDate not supplied

Relationship of new-onset systemic hypertension and normal pressure hydrocephalus.

Communicating normal pressure hydrocephalus (NPH) is an important remote complication of traumatic brain injury (TBI). The diagnosis of this hydrocephalus depends largely on clinical signs and symptoms, including cognitive deterioration, gait changes and incontinence. However, many of these signs are also seen during post-traumatic amnesia, making early recognition of this syndrome difficult. A case study of one man post-TBI, who presented with new-onset hypertension as a sign of NPH, prompted a retrospective chart review of all patients admitted over a 2-year period with a diagnosis of NPH. Ninety per cent of patients had one or more of the classic triad of NPH and 25% of patients had symptoms suggestive of raised intracranial pressure (unexplained nausea, headache and visual disturbance). Mean systolic and diastolic blood pressures among the 20 subjects for six consecutive days pre-operatively compared with those for days 8-14 and 15-21 post-operatively showed no significant differences; a subgroup of five patients (25%), however, demonstrated a significant change in blood pressure temporally related to shunting. We suggest that demonstration of new-onset systemic hypertension may also be a clinical sign suggestive of NPH useful in the evaluation of the TBI patient.

Adolescent↗

PubMed2000

Late sequelae after high midface trauma.

The upper midface area comprises mainly the naso-orbito-ethmoidal (NOE) region which plays a paramount role in facial expression. Fractures of this area often result in neglected bony defects in the fragile periorbital region with major secondary impairments such as traumatic telecanthus, orbital dystopia, and/or enophthalmos. Permanent cranial nerve deficits also can occur as the result of post-traumatic/post-operative sequelae. Seventy-one patients (age range 7-78 years) with severe high midface trauma, treated from January 1989 to December 1996, were reviewed with a minimum follow-up of 2 years. The patient population has been distributed according to the fracture type in three groups: Group 1 (n = 35): Isolated NOE with/without associated central midface injury; Group 2 (n = 22): NOE associated with craniofacial injury and Group 3 (n = 14): NOE associated with orbital displacement. The estimated post-surgical parameters included qualitative and quantitative data from the long-term clinical evaluation. Persistent headache and/or concentration difficulties were mainly noted in Group 1. Smell reduction or anosmia was reported mainly in Group 2. Deficits of the trigeminal and/or the facial nerve were found in Group 3. Enophthalmos and/or telecanthus were predominantly seen with injuries associated with orbital displacement.

Adolescent↗

PubMed2002

Children's well-being after the war in Kosovo: survey in 2000.

AIM: To assess special health and psychosocial needs of Albanian children in Kosovo shortly after the dramatic ethnic conflict in this part of former Yugoslavia in 1999. METHODS: The survey included representative samples of school-age children (n=813), parents (n=41), and teachers (n=31) from six public schools in Prishtina and surrounding area. The measuring instruments included a standardized inventory of children's coping behavior in stressful situations (Ryan-Wegner Coping Style Inventory, SCSI), and survey questionnaires for children, parents, and school teachers, which were also used in a parallel study in Bosnia and Herzegovina (Sarajevo) on comparable survey samples. The study was accomplished in April 2000, ie, only a few months after the crisis in Kosovo. RESULTS: At the time of the survey, many children in Prishtina and surrounding area lived in unhealthy and dangerous physical environment. There were frequent lack of electricity (74%), lack of safe drinking water (68%), garbage on the streets (63%), and firearms, explosive devices, and mine fields in close environment (45%). Many of them showed signs and symptoms of ill health, including frequent headaches (60%), stomach ache (41%), frequent high fever (32%), and sleeplessness (18%). Most of them felt unsafe on the streets (61%). Many of them had rather unhealthy eating habits, such as not having breakfast regularly (16%) or not having a morning snack (60%). Three major groups of stressors were identified as having impact on children's health and psychosocial well-being in Kosovo, as follows: 1) lack of cultural and social security resources at home and in the community at large (20% of common variance explained); 2) poor physical and mental health conditions (14% of common variance); and 3) school-related stressors (11% of common variance). Similarly, parents and teachers also lived and worked under stressful life conditions. Many parents feared the impact of traumatic war experiences on children's health (54%), and school teachers noticed high rates of children's learning and behavioral disorders (84%). Factor analysis of the SCSI proved the hypothesis that in stressful situations children tend to use two major coping strategies: either active, ie, object-focused coping (13% of variance explained) or passive, ie, self-focused coping (10% of variance explained), the later being more typical for younger children. The pattern of stressors and coping behaviors were similar to stressors impacting physical and mental health of children in Sarajevo, although there were a number of culture-specific differences. CONCLUSION: Environmental, educational, and social conditions must be respected in assessing impact of war and conflict on children. Promotion of solidarity, tolerance, and mutual support among children from different ethnic and cultural backgrounds should be encouraged.

Adaptation, Psychological↗

PubMed1988

[Post-traumatic hypoliquorrhea syndrome].

A case of traumatic low pressure headache syndrome after a fall on the buttocks is described. This rare syndrome is probably caused by unusual cerebrospinal fluid leakage. The headaches are characterized by accentuation in the erect position and relieved by recumbency, and may be associated with nausea, vomiting, dizziness, photophobia and vertigo. Carefully executed lumbar puncture in the lateral recumbent position shows absent CSF pressure and even spontaneous aspiration of air through the lumbar puncture needle. Intracranial air resulting from puncture may be demonstrated on routine roentgenogram. In computed tomography the syndrome is associated with extremely small ventricles and tight basal cisterns. Management consists in bedrest and fluid substitution.

Accidental Falls↗

PubMedDate not supplied

[Pathogenesis and psychosocial consequences of post-concussion syndrome].

About 35% of subjects with head injury (HI) suffer from postconcussion syndrome (PCS). These disturbances can be chronic or even permanent. Such patients are discharged from hospital without any apparent problems, but it is often the case that their families, and sometimes even they themselves, start to notice the emergence of new problems. They may exhibit affective changes, such as thinking that they are worthless, alone and without any future perspectives. When they are left without the help of specialists and/or family and friends, their problems gain even greater significance. PCS includes subjective physical complaints (i.e. headache, dizziness) and cognitive, emotional and behavioral changes. PCS influences all areas of the patient's life. Subjects who have sustained head injury often have problems with marital relationships, maintaining of independence, employment, leisure activities and other functions which are related to social adjustment. Various studies have attempted to predict the post-injury status of HI patients from information available, such as data on the severity of head injury, the duration of post-traumatic amnesia (PTA) and the results of neuropsychological assessment. This kind of prediction is important in planning of rehabilitation services and thus improving the kind of help available to survivors of HI. Early prediction of post-injury psychological status may also help the patient and his family in coping with the difficulties related to the trauma. We know a great deal about head injury and its consequences, but many questions still need to be answered. Among these are issues such as: the role of neurobehavioral data in the prediction of outcome for HI patients, the identification of variables determining the extent of PCS and the search for reliable factors which may influence future employment or school status. The assessment of patients for invalidity and other social security benefits also requires a more rational approach, based on the data available.

Brain Concussion↗