More than a fifth of people who suffer mild traumatic brain injury experience Post-Concussion Syndrome 3 and 6 months later, a prospective study of 107 patients found. Post-Concussion Syndrome can prevent optimal recovery from the traumatic brain injury and impose a lifetime of functional disability.
That translates to potentially a lot of people walking around with the syndrome, comprised of a cluster of physical, cognitive, emotional, and behavioral symptoms including headache, fatigue, sleep disturbance, and more. More than 1 million people each year present to emergency departments in the United Kingdom with traumatic brain injury, 90% of them mild cases. Because of difficulty in detecting early symptoms and delay in seeking treatment, mild traumatic brain injury has been called a silent epidemic.
Dr. Ruihua Hou
To help identify patients at risk for the syndrome, Dr. Ruihua Hou and her associates integrated the biological, cognitive, emotional, behavioral, and social factors of Post-Concussion Syndrome into a cognitive behavioral model.
They assessed patients at baseline using a battery of tools including the Brief Illness Perception Questionnaire, the Behavioral Response to Illness Questionnaire, the Impact of Event Scale, the Hospital Anxiety and Depression Scale, the Brief Social Support Questionnaire, the Rivermead Postconcussion Symptoms Questionnaire, and others. They looked for factors that might identify the 22% of patients who experienced Post-Concussion Syndrome 3 months later and the 21% with the syndrome at 6 months.
Patients who exhibited an “all or nothing” behavior pattern shortly after mild traumatic brain injury were 14% more likely to develop Post-Concussion Syndrome by 3 months compared with other patients (significant to a P value of 0.002), Dr. Hou reported in a prize-winning poster at the annual congress of the European College of Neuropsychopharmacology. Patients with negative perceptions or beliefs about illness soon after their injury were 5% more likely to have Post-Concussion Syndrome by 6 months compared with other patients (P = 0.02), said Dr. Hou, a research fellow in psychiatry at the University of Southamptom, England.
The findings suggest that patients’ coping behaviors and illness perceptions may play roles in the development of Post-Concussion Syndrome. Addressing these factors with interventions soon after mild traumatic brain injury might reduce risk for the syndrome, Dr. Hou suggested.
She and her associates had no conflicts of interest.
Traumatic brain injury seems to be more on the mind of psychiatrists these days. An entire session was devoted to the topic at the American Psychiatric Association meeting earlier this year, some of which I reported previously.
--Sherry Boschert (@sherryboschert)