Management of Psychological Complications Following Mild Traumatic Brain Injury

Silverberg, Noah D.; Mikolić, Ana

doi:10.1007/s11910-023-01251-9

Cited by 11 publications

(7 citation statements)

References 124 publications

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“…To date, the biopsychosocioecological model [35] integrates the effects of psychological factors on the recovery from concussions; thus, the treatment of psychological symptoms might also impact the recovery of non-psychological complications [36]. Conventional medical therapies (e.g., antidepressants or anxiolytics), psychological approaches, and rehabilitation interventions are commonly used for these symptoms [36]; however, they are mostly based on trials assessing primary mental health disorders, while anti-depressants for treating TBI-related major depressive disorder have been challenged by a meta-analysis [37], and cognitive behavioral therapy has also shown limited benefits for immediate and shortterm psychological PPCS [38].…”

Section: Psychological Symptomsmentioning

confidence: 99%

A Scoping Review on the Use of Non-Invasive Brain Stimulation Techniques for Persistent Post-Concussive Symptoms

Khosravi,

Louras,

Martens

et al. 2024

Biomedicines

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Background: In the context of managing persistent post-concussive symptoms (PPCS), existing treatments like pharmacotherapy, cognitive behavioral therapy, and physical rehabilitation show only moderate effectiveness. The emergence of neuromodulation techniques in PPCS management has led to debates regarding optimal stimulation parameters and their overall efficacy. Methods: this scoping review involved a comprehensive search of PubMed and ScienceDirect databases, focusing on controlled studies examining the therapeutic potential of non-invasive brain stimulation (NIBS) techniques in adults with PPCS. Results: Among the 940 abstracts screened, only five studies, encompassing 103 patients (12 to 29 per study), met the inclusion criteria. These studies assessed the efficacy of transcranial direct current stimulation (tDCS), or repetitive transcranial magnetic stimulation (rTMS), applied to specific brain regions (i.e., the left dorsolateral pre-frontal cortex (DLPFC) or left motor cortex (M1)) for addressing cognitive and psychological symptoms, headaches, and general PPCSs. The results indicated improvements in cognitive functions with tDCS. In contrast, reductions in headache intensity and depression scores were observed with rTMS, while no significant findings were noted for general symptoms with rTMS. Conclusion: although these pilot studies suggest promise for rTMS and tDCS in PPCS management, further research with larger-scale investigations and standardized protocols is imperative to enhance treatment outcomes for PPCS patients.

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Section: Psychological Symptomsmentioning

confidence: 99%

A Scoping Review on the Use of Non-Invasive Brain Stimulation Techniques for Persistent Post-Concussive Symptoms

Khosravi,

Louras,

Martens

et al. 2024

Biomedicines

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“…Empirical research evidence has shown that ACT is an effective therapeutic approach for PTSD veterans with social difficulties [24][25][26][27][28][29][30]. In a number of scientific works, the effectiveness of ACT intervention to facilitate psychological adaptation and reduce psychological distress after TBI [31][32][33][34], including comorbidity with PTSD, has been proven.…”

Section: модифікована психотерапія прийняття та зобов'язання в компле...mentioning

confidence: 99%

Modified Acceptance and Commitment Psychotherapy in Complex Treatment of Comorbidity of Post-traumatic Stress Disorder and Mild Traumatic Brain Injury

Smashna

2023

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The objective: approbation of the effectiveness of modified Acceptance and Commitment Therapy in a complex treatment of patients with comorbidity of posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Materials and methods. 329 veterans from three clinical groups: individuals with PTSD (n=109), with mild TBI (n=112) and with comorbid PTSD + TBI (n=108), underwent a course of combined therapy lasting 8 weeks: in addition to standard therapy, they received psychotherapeutic intervention (psychoeducation with elements of motivational interviewing and acceptance and commitment therapy for PTSD) and transcranial direct current stimulation (tDCS). The evaluation of the effectiveness of the treatment, in addition to a comprehensive psychodiagnostic examination before and after the therapy, included the Quality of Life Assessment Scale (O. Chaban). Results. Based on the obtained data, we can assume that representatives of the PTSD group, who initially evaluated the quality of social aspects of their lives more negatively, after the therapy looked more positively at the emotionally colored spheres of life (sex and mood). At the same time, after the therapy, the feeling of satisfaction with life was more positively assessed by those patients who were more satisfied with their life conditions before the therapy, and a higher assessment of the quality of life after the therapy was observed in those patients who, even before the therapy, had a higher level of satisfaction with your sex life. Summarizing the obtained data, it can be asserted that as a result of the therapy, the best results in the direction of increasing self-esteem of the quality of life were achieved precisely in relation to patients with PTSD/TBI. Conclusions. Complex treatment of patients with comorbid PTSD and TBI using modified acceptance and Acceptance and Commitment Therapy in combination of standard treatment and tDCS is a promising individual treatment methodology in this patient population.

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“… 1 , 2 , 3 , 4 , 5 The prevalence rates for mental health conditions 3 to 12 months after mTBI are 17% to 27% for depressive disorders, 1 , 6 , 7 11% to 24% for anxiety disorders, 6 , 8 , 9 and 10% to 21% for PTSD. 3 , 5 , 10 , 11 Mental health disorders likely exacerbate persistent postconcussion symptoms (PPCS) 11 , 12 , 13 , 14 , 15 and contribute to the substantial rate (30%-50%) of chronic disability after mTBI. 12 , 16 Outcomes from mTBI could be optimized by proactively monitoring for new or worsened mental health disorders (eg, with self-report screening scales) and initiating mental health treatment.…”

Section: Introductionmentioning

confidence: 99%

“… 12 , 16 Outcomes from mTBI could be optimized by proactively monitoring for new or worsened mental health disorders (eg, with self-report screening scales) and initiating mental health treatment. 15 …”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Mental Health Screening Tools After Mild Traumatic Brain Injury

Gitaari,

Mikolić,

Panenka

et al. 2024

JAMA Netw Open

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ImportanceMental health disorders are common after mild traumatic brain injury (mTBI) and likely exacerbate postconcussive symptoms and disability. Early detection could improve clinical outcomes, but the accuracy of mental health screening tools in this population has not been well established.ObjectiveTo determine the diagnostic accuracy of the Patient Health Questionnaire–9 (PHQ-9), Generalizaed Anxiety Disorder–7 (GAD-7), and Primary Care PTSD (Posttramatic Stress Disorder) Screen for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (PC-PTSD-5) in adults with mTBI.Design, Setting, and ParticipantsThis diagnostic study was performed as a secondary analysis of a cluster randomized clinical trial. Self-report mental health screening tools (PHQ-9, GAD-7, and PC-PTSD-5) were administered online 12 weeks after mTBI and compared against a structured psychodiagnostic interview (Mini-International Neuropsychiatric Interview for DSM-5 (MINI) over videoconference at the same time. Adults with mTBI (N = 537) were recruited from February 1, 2021, to October 25, 2022.Main Outcomes and MeasuresPresence of a major depressive episode, anxiety disorders, and PTSD were determined by a blinded assessor with the MINI. Diagnostic accuracy statistics were derived for the PHQ-9, GAD-7, and PC-PTSD-5. Findings were disaggregated for participants with and without persistent postconcussion symptoms (PPCS) by International and Statistical Classification of Diseases, Tenth Revision criteria.ResultsData were available for 499 of 537 trial participants, 278 (55.7%) of whom were female; the mean (SD) age was 38.8 (13.9) years. Each screening questionnaire had strong diagnostic accuracy in the overall sample for optimal cut points (area under the curve [AUC], ≥0.80; sensitivity, 0.55-0.94; specificity, 0.64-0.94). The AUC (difference of 0.01-0.13) and specificity (difference, 5-65 percentage points) were lower in those with PPCS present compared with PPCS absent, but the prevalence of at least 1 mental health disorder was 3 to 5 times higher in patients with PPCS present. The GAD-7 had slightly better performance than the PC-PTSD-5 for detecting PTSD (AUC, 0.85 [95% CI, 0.80-0.89] vs 0.80 [95% CI, 0.72-0.87]). The optimal cutoff on the PHQ-9 was 5 or more symptoms experienced on more than half of days; on the GAD-7, a total score of at least 7.Conclusions and RelevanceThe findings of this diagnostic study suggest that the PHQ-9, GAD-7 and PC-PTSD-5 accurately screen for mental health disorders in patients with mTBI. Future research should corroborate optimal test cutoffs for this population.

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Management of Psychological Complications Following Mild Traumatic Brain Injury

Cited by 11 publications

References 124 publications

A Scoping Review on the Use of Non-Invasive Brain Stimulation Techniques for Persistent Post-Concussive Symptoms

A Scoping Review on the Use of Non-Invasive Brain Stimulation Techniques for Persistent Post-Concussive Symptoms

Modified Acceptance and Commitment Psychotherapy in Complex Treatment of Comorbidity of Post-traumatic Stress Disorder and Mild Traumatic Brain Injury

Diagnostic Accuracy of Mental Health Screening Tools After Mild Traumatic Brain Injury

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