Factors determining a poor prognosis for adaptation and re-insertion into the workplace are age, a low educational level, a lack of job qualifications and greater cognitive impairments. The significant differences found between the NRS-R of employed and unemployed patients suggest that this variable may be used to predict a subject's ability to return to work.
The results show that, in this group, patients with OPD after TBI present more psychosocial adjustment and emotional problems than patients with TBI without OPD diagnosis. The difference found is independent of cognitive impairments.
Introduction: Controversy exists as to whether post-traumatic stress disorder (PTSD) may occur after traumatic brain injury (TBI). Objective: To describe the clinical presentation and course of a group of patients that developed PTSD following a work-related TBI. Methods: Clinical records of patients with PTSD treated in Hospital del Trabajador between years 1987 and 2001 were examined. Those cases in which a TBI had occurred were selected and compared with those in which a TBI had not preceded the PTSD. Results: 32 patients were identified as suffering PTSD preceded by TBI. All patients had suffered mild TBI; 62.5% of them as a result of a traffic accident. On average, patients were referred for mental health consultation 70 days after TBI had occurred, and 31.2% of them received specialized treatment for less than three months. When discharged 25% were asymptomatic. When compared with 453 patients suffering PTSD, with no history of previous TBI, treated during the same period, those who had suffered TBI presented a greater proportion of physical lesions, more prolonged treatment periods, and a greater proportion of them were still symptomatic when discharged. Discussion: In a group of patients suffering PTSD, history of mild TBI was a factor associated with a worse prognosis.
Introduction: SIN-E-STRES is an adjunct Internet-based intervention for patients with posttraumatic stress disorder (PTSD). Patients interact with the program via a weekly monitoring email and by visiting a website that provides access to psychoeducational information and distance counseling. Aim: to evaluate the acceptability and feasibility of SIN-E-STRES. Methods: forty-five adult PTSD patients were registered to use SIN-E-STRES for three months. This study explores feasibility in terms of patients’ interest in joining the program, reported connectivity and use of the website components, and adherence to monitoring. Acceptability is evaluated through the satisfaction expressed by the participants, their opinions regarding the usefulness of the program, and their evaluation of its positive and negative aspects. Results: most of the patients invited to the program were interested in using SIN-E-STRES, and 73% of the registered patients completed at least one of the monitoring assessments and most of them interacted with the website. The overall monitoring response rate was 35%. Most patients stated that the feedback messages helped them remember themes covered in therapy, they also valued the psychoeducational resources on the website. Conclusions: The program may be especially useful for patients who are frequent Internet and email users. The intervention can be enhanced by improving the monitoring and feedback components as well as by adding complementary psychoeducational information. More research about adherence and dropout of PTSD interventions is necessary. The alignment and coherence of SIN-E-STRES with the main treatment contributes to reinforcing treatment indications and consequently may promote treatment adherence and recovery.
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