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Brain Injury, MDD, Mood, mTBI, NPsychPick, PTSD, Research

Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury A TRACK-TBI Study. JAMA Psychiatry 2019

Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury A TRACK-TBI Study.

Stein, Sonia Jain, Giacino et al. JAMA Psychiatry. 2019; 76(3):249-258.

https://doi.org/10.1001/jamapsychiatry.2018.4288

Published online: January 30, 2019

Abstract

Importance  Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector.

Objective  To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI).

Design, Setting, and Participants  Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study.

Main Outcomes and Measures  Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury.

Results  Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk.

Conclusions and Relevance  After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.

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Brain Injury, Diagnosis, mTBI, Research

Combining H-FABP and GFAP increases the capacity to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury. PLoS ONE, 2019

Lagerstedt L, Egea-Guerrero JJ, Bustamante A, Rodríguez-Rodríguez A, El Rahal A, Quintana-Diaz M, et al. (2018) Combining H-FABP and GFAP increases the capacity to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury. PLoS ONE 13(7): e0200394.

https://doi.org/10.1371/journal.pone.0200394

Abstract:

Mild traumatic brain injury (mTBI) patients may have trauma-induced brain lesions detectable using CT scans. However, most patients will be CT-negative. There is thus a need for an additional tool to detect patients at risk. Single blood biomarkers, such as S100B and GFAP, have been widely studied in mTBI patients, but to date, none seems to perform well enough. In many different diseases, combining several biomarkers into panels has become increasingly interesting for diagnoses and to enhance classification performance.

The present study evaluated 13 proteins individually—H-FABP, MMP-1, MMP-3, MMP-9, VCAM, ICAM, SAA, CRP, GSTP, NKDA, PRDX1, DJ-1 and IL-10—for their capacity to differentiate between patients with and without a brain lesion according to CT results. The best performing proteins were then compared and combined with the S100B and GFAP proteins into a CT-scan triage panel. Patients diagnosed with mTBI, with a Glasgow Coma Scale score of 15 and one additional clinical symptom were enrolled at three different European sites. A blood sample was collected at hospital admission, and a CT scan was performed. Patients were divided into two two-centre cohorts and further dichotomised into CT-positive and CT-negative groups for statistical analysis. Single markers and panels were evaluated using Cohort 1.

Four proteins—H-FABP, IL-10, S100B and GFAP—showed significantly higher levels in CT-positive patients. The best-performing biomarker was H-FABP, with a specificity of 32% (95% CI 23–40) and sensitivity reaching 100%. The best-performing two-marker panel for Cohort 1, subsequently validated in Cohort 2, was a combination of H-FABP and GFAP, enhancing specificity to 46% (95% CI 36–55). When adding IL-10 to this panel, specificity reached 52% (95% CI 43–61) with 100% sensitivity.

These results showed that proteins combined into panels could be used to efficiently classify CT-positive and CT-negative mTBI patients.

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Brain Injury, Criminality, Research

Traumatic Brain Injury and the Risk for Subsequent Crime Perpetration. Bonow, Wang, et al. J Head Trauma Rehabil 2019

Traumatic Brain Injury and the Risk for Subsequent Crime Perpetration

Bonow, Robert H; Wang, Jin, et al. The Journal of Head Trauma Rehabilitation: January/February 2019 – Volume 34 – Issue 1 – p E61–E69

http://doi.org/10.1097/HTR.0000000000000413

Abstract

Objective:

To examine whether patients with traumatic brain injury (TBI) are at higher risk for subsequent crime perpetration compared with injured patients without TBI and those hospitalized for reasons other than injury.

Setting and Participants:

Patients hospitalized in Washington State from 2006-2007.

Design:

A retrospective cohort study using linked statewide datasets.

Main measures:

Primary outcomes were arrest for any violent or nonviolent crime within 5 years of discharge. Adjusted subhazard ratios were calculated using regression models incorporating death as a competing risk.

Results:

Compared with uninjured patients (n = 158 247), the adjusted rate of arrest for any crime was greater among injured patients with TBI (n = 6894; subdistribution hazard ratios [sHR], 1.57; 95% confidence interval [CI], 1.49-1.62) and without TBI (n = 40 035; sHR, 1.55; 95% CI, 1.49-1.62). When patients with TBI were directly compared with injured patients without TBI, no effect of TBI on subsequent arrests was found (sHR, 1.02; 95% CI, 0.94-1.11). TBI did not increase the likelihood of either violent or nonviolent crime when these outcomes were examined separately.

Conclusions:

TBI survivors do not appear to be at increased risk for criminality compared with injured individuals without TBI. However, injured persons with or without TBI may be at elevated risk of crime perpetration compared with those who are uninjured.

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Brain Injury, Health, Quality of Life, Research

The Association between Post-Concussion Symptoms and Health-Related Quality of Life in Patients with Mild Traumatic Brain Injury. Injury, 2018

The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury

Daphne C.Voormolena, Suzanne Polindera, Nicole von Steinbuechel, Pieter E.Vosc, Maryse C.Cnossena, Juanita A.Haagsmaad. Injury. Available online 7 December 2018

https://doi.org/10.1016/j.injury.2018.12.002

A subset of mild traumatic brain injury (mTBI) patients experience post-concussion symptoms. When a cluster of post-concussion symptoms persists for over three months, it is referred to as post-concussion syndrome (PCS). Little is known about the association between PCS and Health-Related Quality of Life (HRQoL) after mTBI. The aims of this study were to assess the implications of PCS on HRQoL six months after mTBI and the relationship between PCS and HRQoL domains. A prospective observational cohort study was conducted among a sample of mTBI patients. Follow-up postal questionnaires at six months after emergency department (ED) admission included socio-demographic information, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and HRQoL measured with the 36-item Short-Form Health Survey (SF-36) and the Perceived Quality of Life Scale (PQoL). In total, 731 mTBI patients were included, of whom 38.7% were classified as suffering from PCS. Patients with PCS had significantly lower scores on all SF-36 domains, lower physical and mental component summary scores and lower mean PQoL scores compared to patients without PCS. All items of the RPQ were negatively correlated to all SF-36 domains and PQoL subscale scores, indicating that reporting problems on any of the RPQ symptoms was associated with a decrease on different aspects of an individuals’ HRQoL. To conclude, PCS is common following mTBI and patients with PCS have a considerably lower HRQoL. A better understanding of the relationship between PCS and HRQoL and possible mediating factors in this relationship could improve intervention strategies, the recovery process for mTBI patients and benchmarking.

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Apps E-Tech, Health, Research, Review

Efficacy of Interventions that Use Apps to Improve Diet, Physical Activity and Sedentary Behaviour: A Systematic Review. IJBNPA, 2016

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review.

Stephanie SchoeppeEmail author, Stephanie Alley, Wendy Van Lippevelde, Nicola A. Bray, Susan L. Williams, Mitch J. Duncan and Corneel Vandelanotte

International Journal of Behavioral Nutrition and Physical Activity. Published: 7 December 2016

 

Background

Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults.

Methods

Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers.

Results

Twenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics, and three of them demonstrated that higher app usage was associated with improved health outcomes.

Conclusions

This review provided modest evidence that app-based interventions to improve diet, physical activity and sedentary behaviours can be effective. Multi-component interventions appear to be more effective than stand-alone app interventions, however, this remains to be confirmed in controlled trials. Future research is needed on the optimal number and combination of app features, behaviour change techniques, and level of participant contact needed to maximise user engagement and intervention efficacy.

https://doi.org/10.1186/s12966-016-0454-y

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Excercise, Mood, Research

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

 

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Brain Injury, Research

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.

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Memory, Research

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.

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Memory, Research

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

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