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PubMed1999

Panic disorder in a patient with traumatic brain injury: a case report and discussion.

Individuals that may be especially susceptible to panic attacks in the rehabilitation setting are patients who have suffered traumatic brain injuries, post-concussion syndrome, lesions, or encephalopathy. An individual is described who suffered a traumatic brain injury and was determined to have suffered a panic attack during his rehabilitation stay. The manifestations of panic attacks are described, using the case report as an example. The psychological aetiology of panic disorders is also reviewed, and treatment options using four major classes of neuropharmacologic agents: benzodiazepines, tricyclic antidepressants, monoamide oxidase inhibitors, and serotonin reuptake inhibitors, are discussed. Given the increasing incidence and survival of patients with traumatic brain injuries, the complications of panic attacks and disorders will become more important; they are a serious condition that can affect an individual's lifestyle, employment, and relationships, and increase the risk of suicide. Rehabilitation specialists should be aware of the manifestations and management of panic attacks and come to appreciate that recognition of this treatable condition is important during all stages of rehabilitation.

Acute Disease↗

PubMed1999

Recovery from mild head injury.

The subjective and objective sequelae accompanying mild head injury (MHI) are discussed in an attempt to clarify MHI's immediate and long-term consequences. Areas covered included epidemiology, classification, the post-concussive syndrome (PCS), malingering, extent of recovery, rehabilitation and guidelines for clinical practice. Special emphasis is placed on the poor relationship between subjective complaint and objective measures of impairment. Also discussed are some of the methodological problems in the MHI literature, including attempts to match MHI subjects and controls with respect to cognitive and emotional complaint and the possible confounding effects of practice. The evidence for long-lasting (i.e. more than 1 year), subtle neurobehavioral impairment after MHI indicates that additional research is required on MHI 1 year or more after injury.

Adolescent↗

PubMed1984

Sensitivity to light and sound following minor head injury.

9 consecutively referred closed head injury (CHI) patients were assessed for sensitivity to light and sound stimuli, within 7-19 days of injury, on both objective and subjective measures. Patients were matched with controls on age, sex, race, socio-economic status and order of test administration. The mean luminance (1366 lux) tolerated by CHI patients was significantly lower (0.01 level by Student's t-test for related samples) than that tolerated by controls (1783 lux). The mean sound intensity tolerated by CHI patients was also lower (82 db) than for controls (94 db), though this difference was not statistically significant. Subjective ratings of sensitivity made by CHI patients after exposure to intense sound and light stimuli, showed no relationship to objective ratings of tolerance. The results demonstrate an objective basis for complaints of increased sensitivity, at least to light, following CHI. These findings do not support earlier "psychogenic" explanations of post-concussion syndrome (PCS) etiology.

Adolescent↗

PubMedDate not supplied

Management of the patient with minor traumatic brain injury.

Staff in the accident and emergency department and critical care unit are often confronted with patients who have sustained life-threatening injuries. In such situations the symptoms of a minor traumatic brain injury (MTBI) may be missed. It is important that, when the physical symptoms begin to subside, nurses are aware of the symptoms of MTBI and respond accordingly. A post-concussion syndrome may develop 2 weeks to 2 months after a MTBI. This syndrome can affect the patient's ability to perform the usual activities of living. This article defines MTBI, describes the symptoms encountered in patients with MTBI, and outlines the pathophysiology, clinical findings, treatment and nursing interventions.

Activities of Daily Living↗

PubMedDate not supplied

Comparison of minor and severe head injury emotional sequelae using the MMPI.

The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 73 patients with traumatic brain injury to objectively evaluate emotional status. Profile analysis indicated that many patients were suffering from emotional disturbance. Higher distress levels were evident among those with minor head injury relative to severe head injury. Observed MMPI profiles for these two head injury groups were consistent with previous research and expectations related to the typical consequences of the post-concussion syndrome. The potential value of the MMPI with the head injury population as well as the need for cautious interpretation and integration of impressions derived from other sources is discussed.

Adult↗

PubMed1995

Late-onset post-concussion symptoms after mild brain injury: the role of premorbid, injury-related, environmental, and personality factors.

The present study investigated the possible role of a number of pre- peri-, and post-traumatic factors in the experience of post-concussion syndrome (PCS). These factors included: (1) history of premorbid risk factors, (2) severity of injury, and (3) post-morbid functioning and environmental factors. Subjects were 55 persons with mild brain injury. PCS was defined in terms of the severity and impact of 'late-onset' symptoms. Pre- and peri-traumatic factors were not associated with level of PCS symptom impact. Among post-traumatic factors, only level of psychological distress was strongly associated with impact level. The results suggest the importance of psychological factors in prolonged PCS.

Activities of Daily Living↗

PubMedDate not supplied

Mild traumatic brain injury does not produce post-traumatic stress disorder.

It has been widely assumed that patients who sustain mild traumatic brain injury (MTBI) or post-concussive syndrome develop post-traumatic stress disorder (PTSD) in response to their cognitive difficulties, diminished coping skills, or other losses. This study examined 70 patients who had previously been diagnosed as having either PTSD or MTBI. Each patient was asked to provide a highly detailed chronological history of the events which preceded, followed, and occurred during the traumatic event, to indicate whether they were rendered unconscious or had amnesia for the event, and to describe the various symptoms they developed. All (100.0%) of the PTSD patients were able to provide a highly detailed and emotionally charged recollection of the events which occurred within 15 minutes of the traumatic event in comparison to none (0.0%) of the MTBI patients. None of the MTBI patients reported symptoms such as intrusive recollections of the traumatic event, nightmares, hypervigilance, phobic or startle reactions, or became upset when they were asked to describe the traumatic event or were exposed to stimuli associated with it. These data suggest that PTSD and MTBI are two mutually exclusive disorders, and that it is highly unlikely that MTBI patients develop PTSD symptoms. Furthermore, these findings suggest that clinicians should exercise considerable caution in ruling out PTSD prior to making the diagnosis of MTBI.

Adaptation, Psychological↗

PubMed1988

Head injury. Integrated rehabilitation approach, optimal adaptation to disability.

Comprehensive rehabilitation of head injury means that all somatic, psychological and social consequences of the accident must be taken into account in order to plan the most appropriate individual therapeutic program. A review is given of the epidemiology, the different types of head injuries and the management in the acute stage and the rehabilitation stage with special reference to severe and moderate head injuries as well as minor head injuries and post-concussion syndrome.

Communication Devices for People with Disabilities↗

PubMed1984

Perilymphatic fistula--a definitive and curable cause of vertigo following head trauma.

Vertigo or disequilibrium occurring in patients after concussive and nonconcussive head trauma may be due to a pathologic perilymphatic fistula from the inner ear through the oval and round window areas of the middle ear. Of 33 patients who had successful grafting of the fistulous area at middle ear exploration, 32 had resolution of vertigo, and 12 of 23 who had an associated hearing loss had improved hearing. Perilymphatic fistulas associated with vertigo and hearing loss after head trauma can be diagnosed with great certainty and are surgically curable in the great majority of cases. Patients with post-concussive syndrome, whose symptoms include vertigo or disequilibrium, should have a thorough otologic evaluation for the possibility of a perilymphatic fistula.

Craniocerebral Trauma↗

PubMed1993

[Post-traumatic psychological disorders].

Mental disorders after closed-head injury are reviewed. Post-concussive syndrome and post-contusional disability are described with particular emphasis on consciousness disorders, amnesia, frontal disturbance and long-term outcome.

Brain Concussion↗

PubMed1993

Defrocking the fraud: the detection of malingering.

The purpose of this paper is to provide psychiatrists with practical advice on how to detect malingered mental illness. Various types of malingering are defined and the five major purposes of malingering are specified. The research literature on malingering is reviewed. Clinicians must be thoroughly grounded in the phenomenology of true mental disease to detect malingering. Detailed information about hallucinations is reviewed so that faked hallucinations that do not follow typical patterns can be more easily identified. Strategies for approaching persons suspected of malingering are suggested. Features of malingered mutism, mania, depression and mental retardation are described. The differential diagnosis of malingering, post-traumatic stress disorder, conversion disorder, and post-concussion syndromes after trauma is discussed. Clues to malingered psychoses and post-traumatic stress disorders are delineated. Finally, specific indicators of malingered insanity defenses are identified.

Depressive Disorder↗

PubMed1993

Differentiation of balance deficits through examination of selected components of static stabilometry.

Stabilometry, which measures the body's center of pressure (COP) movements, during relaxed standing, has been used to distinguish individuals with vestibular and neurologic dysfunctions from normal subjects. The purpose of this study was to determine whether mathematical differences in the magnitudes of the COP obtained from six somatosensory testing conditions could be used to discriminate between different types of balance deficits. Stabilometry measures, using a fixed force platform, were obtained from normal (N = 52) and dizzy (N = 149), peripheral vestibular dysfunction (PVD), post-concussion syndrome (PCS), psychogenic (PSG), and unknown/undetermined etiology (UNK). The data significantly differentiated CVD, PVD and PSG patients from normals and between some of the dizzy groups: CVD versus PVD, PCS; and PSG versus CVD, PVD, PCS and UNK. The measures of anterior-posterior COP movements provided the greatest discrimination.

Adolescent↗

PubMedDate not supplied

[Subjective syndrome after head injury].

UNLABELLED: DEFINITION AND CLASSIFICATION PROBLEMS: Post-traumatic or post-commotion syndrome is one of the most controversial entities in studying consequences of craniocerebral trauma. Part of this problem arises from impossibility of adequate translation of the term brain concussion. Post-concussion syndrome is a broader concept than post-commotion and includes, if not a whole, than part of the post-contusion syndrome. There are also some other terms in the literature: post-traumatic syndrome, post head injury syndrome, post head injury syndrome or symptoms and the old term post-traumatic encephalopathy. Terminological imprecisions have not been solved yet, but the notion itself is determined by relative standard symptoms often associated with closed craniocerebral trauma, but without precise connection with the severity of the trauma. In the classification of mental disorders and behavior disorders, this syndrome is coded as FO7.2. ETIOLOGY: In regard to the etiology of this syndrome some authors speak in favor of psychogenic and some of organic etiology, while Levin considers symptoms of post-commotion syndrome to start as organic and persist as psychic. Wechsler classified subjective disorders after head injuries into 4 categories: simulation, traumatic hysteria, traumatic encephalopathy and traumatic neurosis. The author does not deal with the origin of symptoms, whereas the classification itself suggests priority of psychic to organic factors (11). Those who speak in favor of organic etiology, think that axon damage and neuron damage are organic substrate in mild brain injuries, while fibrous degenerations of the cerebral hemisphere and brain stem are the organic base in severe traumas. On the other hand, many scientists primarily point to psychic moments, especially to importance of aggravation and simulation as well as compensation or rental neurosis in persistent post-traumatic syndrome. Most scientists agree that personality characteristics influence the development of post-traumatic syndrome and can predispose aggravation and simulation, whereas these symptoms more often occur in neurotic persons. The latest investigations reveal that classification in regard to etiologic factors--organic and psychogenic--is an anachronism. Long and Novac state that 80% of persons with cerebral trauma spontaneously speak about symptoms of the post-traumatic syndrome, while by targeted evaluation the percentage rises to 90%, so that they think that universality of symptoms points to their common origin. CONCLUSION: If the post-traumatic syndrome is though of as a line with organic dementia at one end and traumatic neuroses at the other, then this syndrome can be placed at different positions. Some authors put it close to the neurotic syndrome or regard it to be the neurotic syndrome itself, while others, mostly due to homogenity of the clinical picture, believe that this syndrome has an organic cause.

Brain Concussion↗

PubMed1998

Return to play guidelines after a head injury.

Presently there are no universally accepted definitions of the grades of concussion or criteria for when to allow the athlete to return to competition after a head injury. What is agreed upon is that in order to avoid cumulative brain damage and the second impact syndrome, no athlete still suffering post-concussion symptoms should return to competition. This article is meant to serve only as a guideline as the final decision in every instance is a clinical judgement.

Biomechanical Phenomena↗

PubMed1989

The perilymph fistula syndrome defined in mild head trauma.

Neurological and neuro-otological studies were carried out on 102 adults with mild cranio-cervical trauma productive of positional vertigo and perilymph fistula as confirmed by laboratory tests, and by the finding of perilymph fistula at tympanotomy in the surgically managed group. In this patient group, all other neurological and neuro-otological diagnoses were excluded, e.g. epilepsy, cerebral palsy, multiple sclerosis, retardation; and for the neuro-otological group those with a history of ototoxicity, labyrinthitis, Meniere's disease, chronic ear infections, or developmental or familial disorders. Emphasis in this study was on mild trauma: fewer than half of the sample had been rendered unconscious in the injury of record, and a third of the cases were of whiplash type, with no loss of consciousness (LOC) and no remembered headstrike. These concomitant lesions comprise the perilymph fistula syndrome (PLFS) with a unique profile of neurological, perceptual, and cognitive deficits resembling a post-concussion injury. A complete description of the clinical picture is given, including psychological, cognitive and diagnostic tests, and the outcome of bedrest vs. surgical management. PLFS can arise from minor trauma, fistula are frequently bilateral (71/102), a mild sensorineural hearing loss is of variable occurrence (53%), secondary hydrops is not uncommon, and women appear more vulnerable than men for developing the syndrome. As based upon combined laboratory techniques and clinical symptomology, fistula were correctly predicted in 61 of 65 laser-operated ears. The positional vertigo component of PLFS was in all cases managed according to a special physical therapy program utilizing exercises for vestibular symptom habituation. Even when diagnosed late, a good-to-excellent outcome was achieved in 70% of treated patients.

Adult↗

PubMed1998

Second-impact syndrome.

Second impact syndrome (SIS) occurs when an athlete who has sustained an initial head injury, most often a concussion, sustains a second head injury before symptoms associated with the first have fully cleared. While most commonly reported in football, the SIS can occur during any sport that can produce head blows. Any athlete still complaining of post-concussion symptoms after a head injury must not be allowed to return to play.

Adolescent↗

PubMed1997

Does premorbid depression influence post-concussive symptoms and neuropsychological functioning?

We examined the contribution of premorbid affective disturbance to persistent post-concussive symptoms and neuropsychological functioning following a mild traumatic brain injury. No differences were observed on self-reported post-concussive symptoms, MMPI scales, or neuropsychological measures between two case-matched groups of patients with and without a history of pre-injury depression. Clinicians are urged to use caution in attributing post-concussive symptoms or neuropsychological deficits to the presence of a pre-existing affective disorder.

Adult↗

PubMed1994

Sequelae of minor head injury: the natural history of post-concussive symptoms and their relationship to loss of consciousness and follow-up.

The character and natural history of post-concussive symptoms were studied in two subject groups: patients admitted to hospital for observation following brief loss of consciousness (LOC) as a result of head injury and patients who attended the accident unit after head injury but not were not admitted. Follow-up data were obtained from the hospitalized group at standardized out-patient interview and from the non-hospitalized group by postal questionnaire. Two- and 12-week data are presented on 24 hospitalized and 58 non-hospitalized patients. The type and frequency of symptoms was similar in the two groups and rank ordering was significantly correlated. However, the reduction in symptom scores (number of symptoms) 12 weeks post-injury was significantly greater in the hospitalized than the non-hospitalized group. The possible significance of this is discussed.

Adolescent↗