Traumatic Brain Injury in Early Childhood and Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Nationwide Longitudinal Study. J Clin Psychiatry, 2018

Traumatic Brain Injury in Early Childhood and Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Nationwide Longitudinal Study.

Chang HK, Hsu JW, Wu JC, Huang KL, Chang HC, Bai YM, Chen T, Chen M. J Clin Psychiatry. 2018 Oct 16;79(6).

https://doi.org/10.4088/JCP.17m11857

OBJECTIVE:

Early childhood (< 3 years of age) is a critical period for neurodevelopment. This study investigated the correlation between early childhood traumatic brain injury (TBI) and subsequent risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental delay (DD) by analyzing a national-scale cohort.

METHODS:

Data from the National Health Insurance Research Database, which comprises health care information from > 99% of the Taiwanese population, were analyzed. Children with TBI in their early childhood were enrolled from 1998-2008, and the incidence of subsequent ADHD, ASD, or DD (according to ICD-9 criteria) was assessed and compared with controls without TBI. Patients’ age, number of TBI events, and TBI severity were investigated for the risk of ADHD, ASD, or DD.

RESULTS:

A total of 7,801 and 31,204 children were enrolled in the TBI and control cohorts, respectively. The TBI cohort exhibited a higher incidence of subsequent ADHD, ASD, or DD than the controls (all P < .001). Diagnoses of ADHD, ASD, or DD in the TBI cohort were made at a younger age compared with the controls. Cox regression demonstrated the highest hazard ratios (HRs) of ADHD, ASD, or DD with repeated TBI events, severe TBI, and TBI events before 1 year of age, with the exception that the HR of ASD did not significantly increase after repeated TBI (P = .335). In addition, cumulative HRs (> 10 years) of ADHD, ASD, or DD were increased after TBI (all P < .001).

CONCLUSIONS:

Data from this study suggest that the incidence of ADHD, ASD, and DD significantly increased after TBI events in early childhood (< 3 years of age). The risk factors include severe TBI, repeated TBI events, and TBI at a younger age. The long-term follow-up demonstrated an increased cumulative risk of ADHD, ASD, and DD after TBI.

Special Issue – Therapeutic Benefits of Physical Activity for Mood: A Systematic Review on the Effects of Exercise Intensity, Duration, and Modality. J Psychol, 2018

Special Issue – Therapeutic Benefits of Physical Activity for Mood: A Systematic Review on the Effects of Exercise Intensity, Duration, and Modality.

John S. Y. Chan, Guanmin Liu, Danxia Liang, Kanfeng Deng, Jiamin Wu & Jin H. Yan.

Published online: 15 Oct 2018 The Journal of Psychology: Interdisciplinary and Applied.

Abstract

In contemporary society, people experience considerable stress in their daily lives. Therefore, developing effective approaches and convenient means to cope with their mood problems is important nowadays. Physical activity has been consistently reported as a cost-effective way to improve physical fitness, prevent mental illnesses, and alleviate mood problems. In this systematic review, the effects of exercise intensity, duration, and modality on mood change are discussed.

Results show that moderate-intensity anaerobic exercise is associated with greater mood improvements. The relationship between exercise duration and mood change is non-linear; A regime of 10- to 30-minute exercise is sufficient for mood improvements. For exercise modality, anaerobic exercise improves mood, but the efficacy of aerobic and mindfulness-related exercises remains to be further examined.

In addition to the systematic review of potential moderators, a narrative review of psychological and neurophysiological theories of exercise effects on mood is provided; we have highlighted the central role of neuroplasticity in integrating the two classes of theories. An adoption of neuroimaging techniques in future research is critical to reveal the mechanisms underpinning the therapeutic influence of physical activity on affective responses. Some future research directions are also raised.

https://doi.org/10.1080/00223980.2018.1470487

 

Direct Electrical Stimulation of Lateral Orbitofrontal Cortex Acutely Improves Mood in Individuals with Symptoms of Depression

Direct Electrical Stimulation of Lateral Orbitofrontal Cortex Acutely Improves Mood in Individuals with Symptoms of Depression, Vikram R. Rao, Kristin K. Sellers, Deanna L. Wallace, Maryam M. Shanechi, Heather E. Dawes, Edward F. Chang. Current Biology. Published: November 29, 2018

Summary

Mood disorders cause significant morbidity and mortality, and existing therapies fail 20%–30% of patients. Deep brain stimulation (DBS) is an emerging treatment for refractory mood disorders, but its success depends critically on target selection. DBS focused on known targets within mood-related frontostriatal and limbic circuits has been variably efficacious.

Here, we examine the effects of stimulation in orbitofrontal cortex (OFC), a key hub for mood-related circuitry that has not been well characterized as a stimulation target. We studied 25 subjects with epilepsy who were implanted with intracranial electrodes for seizure localization. Baseline depression traits ranged from mild to severe. We serially assayed mood state over several days using a validated questionnaire. Continuous electrocorticography enabled investigation of neurophysiological correlates of mood-state changes. We used implanted electrodes to stimulate OFC and other brain regions while collecting verbal mood reports and questionnaire scores.

We found that unilateral stimulation of the lateral OFC produced acute, dose-dependent mood-state improvement in subjects with moderate-to-severe baseline depression. Stimulation suppressed low-frequency power in OFC, mirroring neurophysiological features that were associated with positive mood states during natural mood fluctuation. Stimulation potentiated single-pulse-evoked responses in OFC and modulated activity within distributed structures implicated in mood regulation. Behavioral responses to stimulation did not include hypomania and indicated an acute restoration to non-depressed mood state.

Together, these findings indicate that lateral OFC stimulation broadly modulates mood-related circuitry to improve mood state in depressed patients, revealing lateral OFC as a promising new target for therapeutic brain stimulation in mood disorders.

https://doi.org/10.1016/j.cub.2018.10.026

Perceived Post-traumatic Growth May Not Reflect Actual Positive Change: A Short-term Prospective Study of Relationship Dissolution

Perceived post-traumatic growth may not reflect actual positive change: A short-term prospective study of relationship dissolution, Meghan Owenz, Blaine J. Fowers. Journal of Social and Personal Relationships. Article first published online: November 19, 2018.

Abstract

Romantic relationship breakups induce significant distress, which has prompted interest in the possibility of post-traumatic growth (PTG) following relationship dissolution. However, most studies have relied on retrospective self-reports of growth, raising questions about the actuality of growth following breakup. 

This prospective study assessed relationship quality prior to breakup, measured growth over time, included a comparison group that did not experience breakup, and tested rival hypotheses to assess PTG in comparison with positive reappraisal (PR). College students (N = 599) in romantic relationships were recruited as participants and assessed at two time points approximately 10 weeks apart. The primary sample includes participants who experienced a relationship breakup (N = 100).

Results indicated that, following a breakup, participants reported a high degree of breakup distress and perceived growth. The pattern of results suggests that reports of perceived PTG may reflect PR processes, as evidenced by the correlation between optimism at Time 1 and perceived, but not actual, PTG at Time 2. 

Consistent with previous prospective research, but differing from much of the retrospective research, a measure of “actual growth” was unrelated to distress, perceived growth, or whether the individual experienced a breakup. The results corroborate research suggesting that retrospective reports of PTG may not reflect actual personal growth measured before and after a traumatic event.

The Brain Injury Rehabilitation Workbook

The Brain Injury Rehabilitation Workbook edited by Rachel Winson, Barbara A. Wilson, and Andrew Bateman.

Packed with practical tools and examples, this state-of-the-art workbook provides a holistic framework for supporting clients with acquired brain injury. Clinicians are guided to set and meet collaborative treatment goals based on a shared understanding of the strengths and needs of clients and their family members. Effective strategies are described for building skills and teaching compensatory strategies in such areas as attention, memory, executive functions, mood, and communication. Particular attention is given to facilitating the challenging process of identity change following a life-altering injury. In a large-size format for easy photocopying, the volume features 93 reproducible client handouts. Purchasers get access to a Web page where they can download and print the reproducible materials.

The Surprisingly Powerful Influence of Drawing on Memory

The Surprisingly Powerful Influence of Drawing on Memory by Myra A. Fernandes, Jeffrey D. Wammes, Melissa E. Meade. First Published August 30, 2018.

Abstract: The colloquialism “a picture is worth a thousand words” has reverberated through the decades, yet there is very little basic cognitive research assessing the merit of drawing as a mnemonic strategy. In our recent research, we explored whether drawing to-be-learned information enhanced memory and found it to be a reliable, replicable means of boosting performance. Specifically, we have shown this technique can be applied to enhance the learning of individual words and pictures as well as textbook definitions. In delineating the mechanism of action, we have shown that gains are greater from drawing than other known mnemonic techniques, such as semantic elaboration, visualization, writing, and even tracing to-be-remembered information. We propose that drawing improves memory by promoting the integration of elaborative, pictorial, and motor codes, facilitating the creation of a context-rich representation. Importantly, the simplicity of this strategy means it can be used by people with cognitive impairments to enhance memory, with preliminary findings suggesting measurable gains in performance in both normal aging individuals and patients with dementia.

Retrograde Personal Semantic Memory During Post-Traumatic Amnesia and Following Emergence

Retrograde Personal Semantic Memory During Post-Traumatic Amnesia and Following Emergence. Caroline M. Roberts, Gershon Spitz, Matthew Mundy and Jennie L. Ponsford. Journal of the International Neuropsychological Society. Volume 24, Issue 10 November 2018, pp. 1064-1072.

Objectives: Anecdotal reports suggest that following traumatic brain injury (TBI) retrograde memories are initially impaired and recover in order of remoteness. However, there has been limited empirical research investigating whether a negative gradient in retrograde amnesia—relative preservation of remote over recent memory—exists during post-traumatic amnesia (PTA) compared with the acute phase post-emergence. This study used a repeated-measures design to examine the pattern of personal semantic (PS) memory performance during PTA and within two weeks of emergence to improve understanding of the nature of the memory deficit during PTA and its relationship with recovery.

Methods: Twenty patients with moderate-severe TBI and 20 healthy controls (HCs) were administered the Personal Semantic Schedule of the Autobiographical Memory Interview. The TBI group was assessed once during PTA and post-emergence. Analysis of variance was used to compare the gradient across lifetime periods during PTA relative to post-emergence, and between groups.

Results: PS memory was significantly lower during PTA than post-emergence from PTA, with no relative preservation of remote memories. The TBI group was still impaired relative to HCs following emergence from PTA. Lower overall PS memory scores during PTA were associated with increased days to emerge from PTA post-interview.

Conclusions: These results suggest a global impairment in PS memory across lifetime periods particularly during PTA, but still present within 2 weeks of emergence from PTA. PS memory performance may be sensitive to the diffuse nature of TBI and may, therefore, function as a clinically valuable indicator of the likely time to emerge from PTA. (JINS, 2018, 24, 1064–1072).

https://doi.org/10.1017/S1355617718000565

Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study

Torous J, Wisniewski H, Liu G, Keshavan M. (2018). Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study. JMIR Ment Health 2018;5(4):e11715.

A total of 113 patients at the private insurance clinic and 73 at the state DMH clinic completed the survey. Those in the private insurance clinic were more likely to download a mental health app compared to the state DMH clinic, but actual rates of reported current app usage were comparable at each clinic, approximately 10%.

Conclusions: High interest in mental health apps does not automatically translate into high use. Patients may require continuous support in using relevant health apps.

https://mental.jmir.org/2018/4/e11715/

Association of Concussion With the Risk of Suicide

Michael Fralick, Eric Sy, Adiba Hassan, et al. (2018). Association of Concussion With the Risk of Suicide. A Systematic Review and Meta-Analysis. JAMA Neurol. Published online November 12, 2018.

Systematic review and meta-analysis found a 2-fold higher risk of subsequent suicide among more than 700 000 patients diagnosed with concussion and/or mild TBI, compared with more than 6.2 million individuals who had not been so diagnosed. Experiencing concussion and/or mild TBI was also associated with a higher risk of suicide attempt and suicidal ideation.

These results suggest that experiencing concussion and/or mild TBI is associated with an increased risk of suicide.

https://jamanetwork.com/journals/jamaneurology/fullarticle/2712851

Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury

Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury, Journal of Neurotrauma, September 2018, F. Hammond; J. Giacino; R. Nakase-Richardson; J. A. Haley; X. Tang.

Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI).

This study examined functional status during the first ten years after TBI among a cohort with disorders of consciousness (i.e., coma, vegetative state, minimally conscious state).

The study sample included 110 individuals with TBI who were unable to follow commands prior to inpatient rehabilitation and for whom follow-up data were available at 1, 2, 5, and 10 years post-injury.

The sample was subdivided into those who demonstrated command-following early (before 28 days post-injury) versus late (>28 days post-injury or never).

Measureable functional recovery occurred throughout the 10-year period, with more than 2/3 of the sample achieving independence in mobility and self-care, and about 1/4 achieving independent cognitive function by 10 years.

Following commands prior to 28 days was associated with greater functional independence at all outcome time points.

More than half the sample achieved near-maximal recovery by 1-year post-injury, while the later command-following subgroups recovered over longer periods of time. Significant late functional decline was not observed in this cohort.

The proportion of participants achieving functional independence increased between 5 and 10 years post-injury.

These findings suggest that individuals with disorders of consciousness may benefit from ongoing functional monitoring and updated care plans for at least the first decade after TBI.

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