Background and aim Postconcussion syndrome (PCS) is a term used to describe the complex, and controversial, constellation of physical, cognitive and emotional symptoms associated with mild brain injury. At the current time, there is a lack of clear, evidence-based treatment strategies. In this systematic review, the authors aimed to evaluate the potential efficacy of cognitive behavioural therapy (CBT) and other psychological treatments in postconcussion symptoms. Methods Four electronic databases were searched up to November 2008 for studies of psychological approaches to treatment or prevention of postconcussion syndrome or symptoms. Results The search identified 7763 citations, and 42 studies were included. This paper reports the results of 17 randomised controlled trials for psychological interventions which fell into four categories: CBT for PCS or specific PCS symptoms; information, reassurance and education; rehabilitation with a psychotherapeutic element and mindfulness/relaxation. Due to heterogeneity of methodology and outcome measures, a meta-analysis was not possible. The largest limitation to our findings was the lack of high-quality studies.
Aims and methodConcerns have been raised that catatonia is underdiagnosed. Prevalence varies (1.3-32%) depending on diagnostic criteria. We used the Modified Rogers Scale to rate catatonic signs in patients consecutively admitted to three psychiatric wards over a 10-month period.ResultsThe prevalence of patients demonstrating any catatonic signs was at least 7.9-19.1%. The most common catatonic signs were marked underactivity (not sedated), echolalia/palilalia, marked overactivity (not restlessness) and gegenhalten. In those with catatonic signs, the most common diagnoses were schizophrenia, schizoaffective disorder and dementia.Clinical implicationsMost of the most common catatonic signs in our sample were motor signs. Antipsychotic-induced motor signs reflect interaction between drug and disease. Catatonic signs are not anchored in any one diagnosis and are on a spectrum of severity and quantity. Prevalence of these signs is higher than often presumed.
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