PTSD and TBI co-morbidity: Scope, clinical presentation and treatment options

Tanev, Kaloyan S.; Pentel, Kimberly Z.; Kredlow, M. Alexandra; Charney, Meredith E.

doi:10.3109/02699052.2013.873821

Cited by 123 publications

(77 citation statements)

References 98 publications

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“…29 Given that most PTSD cases in this study received psychological treatment, the absence of an established evidence base for treating PTSD following TBI may contribute to symptom chronicity. 56 It may be that the reduced cognitive resources available following TBI and/or the event-related amnesia preclude adequate processing of the trauma, therefore prolonging symptom remission. Further, damage to the medial prefrontal cortex may impede an individual's capacity to emotionally regulate fear.…”

Section: Discussionmentioning

confidence: 99%

The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury

Alway

Gould

McKay

et al. 2016

Journal of Neurotrauma

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Increasing evidence indicates that post-traumatic stress disorder (PTSD) may develop following traumatic brain injury (TBI), despite most patients having no conscious memory of their accident. This prospective study examined the frequency, timing of onset, symptom profile, and trajectory of PTSD and its psychiatric comorbidities during the first 4 years following moderate-to-severe TBI. Participants were 85 individuals (78.8% male) with moderate or severe TBI recruited following admission to acute rehabilitation between 2005 and 2010. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders (SCID-I), participants were evaluated for pre- and post-injury PTSD soon after injury and reassessed at 6 months, 12 months, 2 years, 3 years, and 4 years post-injury. Over the first 4 years post-injury, 17.6% developed injury-related PTSD, none of whom had PTSD prior to injury. PTSD onset peaked between 6 and 12 months post-injury. The majority of PTSD cases (66.7%) had a delayed-onset, which for a third was preceded by subsyndromal symptoms in the first 6 months post-injury. PTSD frequency increased over the first year post-injury, remained stable during the second year, and gradually declined thereafter. The majority of subjects with PTSD experienced a chronic symptom course and all developed one or more than one comorbid psychiatric disorder, with mood, other anxiety, and substance-use disorders being the most common. Despite event-related amnesia, post-traumatic stress symptoms, including vivid re-experiencing phenomena, may develop following moderate-to-severe TBI. Onset is typically delayed and symptoms may persist for several years post-injury.

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Section: Discussionmentioning

confidence: 99%

The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury

Alway

Gould

McKay

et al. 2016

Journal of Neurotrauma

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“…There are a number of therapeutic approaches that may be helpful in treating and preventing emotional distress and mood disorders secondary to TBI [56][57][58]. Several case studies [59,60] and one small randomized controlled trial (RCT) [61] report on the effectiveness of Cognitive Behavioural Therapy (CBT) in managing PTSD, anxiety and depression in TBI samples.…”

Section: Discussionmentioning

confidence: 99%

Identifying longitudinal trajectories of emotional distress symptoms 5 years after traumatic brain injury

et al. 2014

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

McAllister

Zafonte

Jain

et al. 2015

Neuropsychopharmacol

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We report findings from a 12-week randomized double-blinded placebo-controlled trial of methylphenidate or galantamine to treat emotional and cognitive complaints in individuals (n = 32) with a history of PTSD, TBI, or both conditions. In this small pilot study, methylphenidate treatment was associated with clinically meaningful and statistically significant improvement compared with placebo on the primary outcome, a measure of cognitive complaints (Ruff Neurobehavioral Inventory-Postmorbid Cognitive Scale), as well as on the secondary outcomes reflecting post-concussive (Rivermead Post Concussive Symptom Questionnaire) and post-traumatic stress symptoms (Posttraumatic Stress Disorder Checklist). Treatment was well tolerated. These results suggest the need for a larger RCT to replicate and confirm these findings. Design considerations for such a trial should include the need for multiple sites to facilitate adequate recruitment and extension of the treatment and follow-up periods.

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PTSD and TBI co-morbidity: Scope, clinical presentation and treatment options

Cited by 123 publications

References 98 publications

The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury

The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury

Identifying longitudinal trajectories of emotional distress symptoms 5 years after traumatic brain injury

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

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