Can ‘partial’ PTSD explain differences in diagnosis of PTSD by questionnaire self-report and interview after head injury?

Chalton, L. D.; McMillan, T. M.

doi:10.1080/02699050802635273

Cited by 21 publications

(10 citation statements)

References 33 publications

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“…12 One of the common standardized tests for PTSD diagnosis is reported to have poor validity when administered to persons with a TBI, resulting in an inappropriately high rate of PTSD among persons with TBI. 25,108 Unfortunately, many research reports on military epidemiology fail to provide any information about blast other than the patient's self-reported fact that an exposure occurred, thus raising the possibility that reports on TBI may actually represent PTSD, and reported cases of PTSD may actually represent TBI.…”

Section: Fundamental Questionsmentioning

confidence: 96%

Brain Injuries from Blast

et al. 2011

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Traumatic brain injury (TBI) from blast produces a number of conundrums. This review focuses on five fundamental questions including: (1) What are the physical correlates for blast TBI in humans? (2) Why is there limited evidence of traditional pulmonary injury from blast in current military field epidemiology? (3) What are the primary blast brain injury mechanisms in humans? (4) If TBI can present with clinical symptoms similar to those of Post-Traumatic Stress Disorder (PTSD), how do we clinically differentiate blast TBI from PTSD and other psychiatric conditions? (5) How do we scale experimental animal models to human response? The preponderance of the evidence from a combination of clinical practice and experimental models suggests that blast TBI from direct blast exposure occurs on the modern battlefield. Progress has been made in establishing injury risk functions in terms of blast overpressure time histories, and there is strong experimental evidence in animal models that mild brain injuries occur at blast intensities that are similar to the pulmonary injury threshold. Enhanced thoracic protection from ballistic protective body armor likely plays a role in the occurrence of blast TBI by preventing lung injuries at blast intensities that could cause TBI. Principal areas of uncertainty include the need for a more comprehensive injury assessment for mild blast injuries in humans, an improved understanding of blast TBI pathophysiology of blast TBI in animal models and humans, the relationship between clinical manifestations of PTSD and mild TBI from blunt or blast trauma including possible synergistic effects, and scaling between animals models and human exposure to blasts in wartime and terrorist attacks. Experimental methodologies, including location of the animal model relative to the shock or blast source, should be carefully designed to provide a realistic blast experiment with conditions comparable to blasts on humans. If traditional blast scaling is appropriate between species, many reported rodent blast TBI experiments using air shock tubes have blast overpressure conditions that are similar to human long-duration nuclear blasts, not high explosive blasts.

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Section: Fundamental Questionsmentioning

confidence: 96%

Brain Injuries from Blast

et al. 2011

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“…Misdiagnosis of PTSD following TBI can occur because of an overlap of symptoms of PTSD and TBI (such as sleep disturbance, irritability, and poor concentration), and is further compounded by the presence of associated features such as pain and comorbid disorders (Bryant & Harvey, 1998;Chalton & McMillan, 2009;King, 2008a;McMillan, 2001). Key factors in the diagnosis of PTSD in children with TBI are loss of consciousness and memory loss.…”

Section: Ptsd and Pediatric Head Injuriesmentioning

confidence: 98%

Which method of posttraumatic stress disorder classification best predicts psychosocial function in children with traumatic brain injury?

Iselin

Brocque

Kenardy

et al. 2010

Journal of Anxiety Disorders

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“…13 A barrier to understanding the frequency with which PTSD occurs following TBI is the challenge of obtaining an accurate diagnosis. 14 The overlap in symptoms characteristic of both TBI and PTSD (e.g., memory, concentration, and sleep disturbances) makes classifying presenting symptoms difficult. 15 Consequently, the use of self-report PTSD measures results in high rates of false positive diagnoses, as respondents incorrectly attribute TBI sequelae to symptoms of PTSD.…”

Section: Introductionmentioning

confidence: 99%

“…Interpretation of these studies is complex, as they typically have not reported the timing of symptom onset or resolution, and in some cases assessed symptoms experienced up to decades previously. 25,26 Nevertheless, cross-sectional studies ranging from 1 month to 34 years post-injury report PTSD rates of 3% to 40%, 7,14,17,[27][28][29][30][31] while retrospective studies with participants 6 months to 47 years post-injury show post-injury lifetime rates from 0% to 19%. 25,26,29 Delayed-onset PTSD, with onset more than 6 months posttrauma, is considered to be relatively rare, occurring in approximately 15% of civilian PTSD cases.…”

Section: Introductionmentioning

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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Can ‘partial’ PTSD explain differences in diagnosis of PTSD by questionnaire self-report and interview after head injury?

Abstract: These preliminary findings agree with an emerging theme suggesting that, although PTSD can occur after head injury, it is easily over-diagnosed.

Cited by 21 publications

References 33 publications

Brain Injuries from Blast

Brain Injuries from Blast

Which method of posttraumatic stress disorder classification best predicts psychosocial function in children with traumatic brain injury?

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

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