Posttraumatic stress disorder and traumatic brain injury: Are they mutually exclusive?

Joseph, Stephen; Masterson, Jackie

doi:10.1023/a:1024762919372

Cited by 44 publications

(28 citation statements)

References 55 publications

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“…44 Prior cross-sectional studies have also reported associations between TBI and PTSD, 45,46 although injury severity may govern the association. 47,48 Higher morbidity and use of medical services are associated with severe TBI, whereas mental Higher CAPS scores may also reflect nonspecific symptoms that overlap with TBI sequelae. Alternatively, perhaps the overall contexts surrounding severe TBI were more emotionally traumatic than contexts surrounding milder injuries.…”

Section: Discussionmentioning

confidence: 99%

Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines

Yurgil¹,

Barkauskas²,

Vasterling³

et al. 2013

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for the Marine Resiliency Study Team IMPORTANCE Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples.OBJECTIVE To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms. DESIGN, SETTING, AND PARTICIPANTS As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66). MAIN OUTCOMES AND MEASURESThe primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment. RESULTSAt the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported Ն24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms.CONCLUSIONS AND RELEVANCE Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.JAMA Psychiatry.

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Section: Discussionmentioning

confidence: 99%

Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines

Yurgil¹,

Barkauskas²,

Vasterling³

et al. 2013

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“…It has been suggested that the post-traumatic amnesia associated with TBI may protect against the development of PTSD, based on the notion that amnesia for the event precludes formation of the core affective responses associated with the development of PTSD. 51 Although PTSD can clearly develop after even moderate-to-severe TBIs, one prospective study did find that PTSD rates were higher in subjects who remembered the TBI incident than in those with no memory for the event. 52 The studies reported here, which were conducted using general anesthesia, however, suggest that a blast-related mTBI exposure can induce PTSD-related traits independent of exposure to a PTSD stressor.…”

Section: Figmentioning

confidence: 99%

Blast Exposure Induces Post-Traumatic Stress Disorder-Related Traits in a Rat Model of Mild Traumatic Brain Injury

Elder

Dorr²,

Gasperi³

et al. 2012

Journal of Neurotrauma

194

214

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Blast related traumatic brain injury (TBI) has been a major cause of injury in the wars in Iraq and Afghanistan. A striking feature of the mild TBI (mTBI) cases has been the prominent association with post-traumatic stress disorder (PTSD). However, because of the overlapping symptoms, distinction between the two disorders has been difficult. We studied a rat model of mTBI in which adult male rats were exposed to repetitive blast injury while under anesthesia. Blast exposure induced a variety of PTSD-related behavioral traits that were present many months after the blast exposure, including increased anxiety, enhanced contextual fear conditioning, and an altered response in a predator scent assay. We also found elevation in the amygdala of the protein stathmin 1, which is known to influence the generation of fear responses. Because the blast overpressure injuries occurred while animals were under general anesthesia, our results suggest that a blastrelated mTBI exposure can, in the absence of any psychological stressor, induce PTSD-related traits that are chronic and persistent. These studies have implications for understanding the relationship of PTSD to mTBI in the population of veterans returning from the wars in Iraq and Afghanistan.

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“…These mechanisms include the islands of memory within the period of PTA [25,49], short or incomplete amnesia [50], memories from before and/or after the actual event [48], implicit unconscious memories [51][52], and memories based on details the individual has later heard or seen about the event [53][54].…”

Section: Influence Of Posttraumatic Amnesiamentioning

confidence: 99%

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

Kennedy

Jaffee

Leskin³

et al. 2007

JRRD

239

157

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Abstract-In this article, we review the literature on posttraumatic stress disorder (PTSD) and PTSD-like symptoms that can occur along with mild traumatic brain injury (TBI) and concussion, with specific reference to concussive injuries in the military. We address four major areas: (1) clinical aspects of TBI and PTSD, including diagnostic criteria, incidence, predictive factors, and course; (2) biological interface between PTSD and TBI; (3) comorbidity between PTSD and other mental disorders that can occur after mild TBI; and (4) current treatments for PTSD, with specific considerations related to treatment for patients with mild TBI or concussive injuries.

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Posttraumatic stress disorder and traumatic brain injury: Are they mutually exclusive?

Cited by 44 publications

References 55 publications

Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines

Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines

Blast Exposure Induces Post-Traumatic Stress Disorder-Related Traits in a Rat Model of Mild Traumatic Brain Injury

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

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