Exploring the Convergence of Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

Abstract

The authors examine the relationship of the two signature injuries experienced by military personnel serving in Afghanistan and Iraq: posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mild TBI). Studies show that a substantial minority of those serving develop persistent emotional sequelae (such as PTSD and other psychological health problems) and/or somatic or cognitive sequelae (postconcussive symptoms) of traumatic exposure. Remarkably, the mechanism (emotional versus biomechanical) and locus (head versus other regions) of injury are weak determinants of whether an individual develops PTSD, persistent postconcussive symptoms, or both. Preexisting or traumatically acquired cognitive dysfunction can increase the risk for these syndromes, probably by reducing cognitive reserve. Structural and functional neuroimaging studies can be interpreted to explain part of the shared symptomatic and functional variance in these syndromes, but this literature is far from consistent and serves mainly to raise new, challenging questions about mutual pathophysiology. The frequent confluence of PTSD and persistent postconcussive symptoms in military personnel strains the bounds of these constructs. New studies are needed to improve our understanding of how emotional and biomechanical stressors can yield these adverse outcomes and how such outcomes can be prevented and treated.

Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury

“…GAL was associated with improved episodic memory, also consistent with previous work in other populations such as Alzheimer's disease where this agent is FDA approved for treatment of the episodic memory problems that are the hallmark of that disorder. This profile of cognitive enhancement with these two agents is consistent with the proposed neurobiology of underlying mechanisms of cognitive complaints and deficits in TBI (McAllister and Arciniegas, 2002;Arciniegas, 2006;Chew and Zafonte, 2009), and the shared neurobiological underpinnings of symptom overlap in TBI and PTSD (Stein and McAllister, 2009).…”

“…PCS symptoms as measured by the Rivermead Post Concussive Questionnaire were significantly reduced in the MPH group. This may not be overly surprising given the non-specificity of PCS symptoms and the shared symptom profile of mTBI and PTSD that has been noted previously (Stein and McAllister, 2009;McAllister and Stein, 2010). The drop in depressive symptoms on the PHQ9 is also noteworthy given the welldescribed high rates of co-morbid depression in both TBI (Silver et al, 2009;Jorge et al, 2004) and PTSD (Hankin et al, 1999;Brady et al, 2000).…”

“…Although post-concussive (PCS) and post-traumatic stress (PTS) symptoms overlap in multiple domains (Stein and McAllister, 2009), cognitive complaints are particularly troublesome in both conditions. Individuals who suffer mTBI have acute cognitive effects, and a significant number of them have persistent symptoms (McMahon et al, 2014).…”

“…Moreover, there is a high level of co-occurrence of TBI and PTSD in this population. Many observational studies from both military and civilian settings (Hoge et al, 2008;Schneiderman et al, 2008) have firmly established an association between mTBI and PTSD (Hoge et al, 2008;Schneiderman et al, 2008;Carlson et al, 2011;Hart et al, 2014;Stein and McAllister, 2009;Tanev et al, 2014;Wilk et al, 2012;Wisco et al, 2014;Yurgil et al, 2014). These observations signal not only a need for effective interventions for PTSD and mTBI occurring individually, but for interventions that have the potential to address both conditions at the same time.…”

Особливості Когнітивних Порушень При Пораненнях, Отриманих В Умовах Бойових Дій

“…Stein, T.W. McAllister, показавшими, что когнитивные нарушения, предшествовавшие травме, могут по-высить вероятность развития посттравматического стрессового расстройства [8].…”