Neuropsychiatry of Pediatric Traumatic Brain Injury

Max, Jeffrey E.

doi:10.1016/j.psc.2013.11.003

Cited by 49 publications

(37 citation statements)

References 96 publications

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“…Fourteen patients developed NPDs, 2 patients developed isolated suicidal ideation, and 4 additional patients experienced worsening symptoms of a preinjury psychiatric disorder. Previous work has suggested a significant association between TBI and psychiatric disorders in children and adolescents, with rates significantly higher than those observed among uninjured 21,22,41,49 and orthopedically injured controls. 32 Novel psychiatric disorders diagnosed among patients with TBI in these studies were heterogeneous and included depressive disorders, anxiety disorders such as generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and OCD, somatoform disorder, ADHD, and behavioral disorders such as oppositional-defiant disorder and conduct disorder.…”

Section: Discussionmentioning

confidence: 81%

“…32 Novel psychiatric disorders diagnosed among patients with TBI in these studies were heterogeneous and included depressive disorders, anxiety disorders such as generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and OCD, somatoform disorder, ADHD, and behavioral disorders such as oppositional-defiant disorder and conduct disorder. 4,[21][22][23][26][27][28]30,[34][35][36]49 Among the most common NPDs observed among prospective studies has been personality change resulting from a generalized medical condition, which has been diagnosed in up to 40% of pediatric patients after TBI but was not formally assessed in the present study. 22,36 Clinical variables associated with the development of NPDs after pediatric TBI include history of preinjury psychiatric disorder, family history of psychiatric illness, severity of injury, low socioeconomic status, and preinjury adaptive and intellectual functioning.…”

Section: Discussionmentioning

confidence: 99%

“…Previous neuropsychiatry literature has defined NPD as a newly diagnosed psychiatric disorder that occurred in a patient with or without a lifetime preinjury psychiatric disorder after TBI. 22 In this case, a patient who has no preinjury psychiatric history can be diagnosed with an NPD after TBI. In addition, a patient with a previous psychiatric history (i.e., major depressive disorder) can be diagnosed with an NPD (i.e., generalized anxiety disorder) after TBI that was not present before the injury.…”

Section: Definitionsmentioning

confidence: 95%

“…Previous studies have observed novel psychiatric disorders (NPDs) occurring in 10%-100% of children and adolescents with TBI of various severities, including personality changes, attention-deficit hyperactivity disorder (ADHD), behavioral disorders, depression, and anxiety disorders. 4,21,22,[26][27][28]30,31,[33][34][35][36]49 Children and adolescents with psychiatric disorders are at risk for additional long-term comorbidities such as impaired school performance, 9 social isolation, 48 family dysfunction, 55 substance abuse, 45 and suicidal behavior. 19 Successful management of isolated pediatric mood disorders requires a multidisciplinary approach that includes behavioral and pharmacological treatment options.…”

mentioning

confidence: 99%

“…Treatment of an NPD after TBI is more challenging and requires close collaboration between physicians with specialized clinical training and experience in TBI and psychiatry. 22 Despite increased media and research attention surrounding the relationship between SRC, mood disorders, and suicide in professional athletes, 12,14,15,17,40,46,50,52 there have been no clinical studies to examine postinjury psychiatric outcomes among an exclusive cohort of pediatric patients with SRC.…”

mentioning

confidence: 99%

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Psychiatric outcomes after pediatric sports-related concussion

Ellis

Ritchie

Koltek

et al. 2015

PED

167

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J neurosurg Pediatr 16:709-718, 2015 abbreviations ADHD = attention-deficit hyperactivity disorder; ICD-10 = International Classification of Diseases, 10th Revision; IQR = interquartile range; NOS = not otherwise specified; NPD = novel psychiatric disorder; OCD = obsessive-compulsive disorder; PCS = postconcussion syndrome; PCSS = Post-Concussion Symptom Scale; SRC = sports-related concussion; TBI = traumatic brain injury. obJect The objectives of this study were twofold: 1) to examine the prevalence of emotional symptoms among children and adolescents with a sports-related concussion (SRC) who were referred to a multidisciplinary pediatric concussion program and 2) to examine the prevalence, clinical features, risk factors, and management of postinjury psychiatric outcomes among those in this clinical population. methods The authors conducted a retrospective chart review of all patients with SRC referred to a multidisciplinary pediatric concussion program between September 2013 and October 2014. Clinical assessments carried out by a single neurosurgeon included clinical history, physical examination, and Post-Concussion Symptom Scale (PCSS) scoring. Postinjury psychiatric outcomes were defined as a subjective worsening of symptoms of a preinjury psychiatric disorder or new and isolated suicidal ideation or diagnosis of a novel psychiatric disorder (NPD). An NPD was defined as a newly diagnosed psychiatric disorder that occurred in a patient with or without a lifetime preinjury psychiatric disorder after a concussion. Clinical resources, therapeutic interventions, and clinical and return-to-play outcomes are summarized. results One hundred seventy-four patients (mean age 14.2 years, 61.5% male) were included in the study. At least 1 emotional symptom was reported in 49.4% of the patients, and the median emotional PCSS subscore was 4 (interquartile range 1-8) among those who reported at least 1 emotional symptom. Overall, 20 (11.5%) of the patients met the study criteria for a postinjury psychiatric outcome, including 14 patients with an NPD, 2 patients with isolated suicidal ideation, and 4 patients with worsening symptoms of a preinjury psychiatric disorder. Female sex, a higher initial PCSS score, a higher emotional PCSS subscore, presence of a preinjury psychiatric history, and presence of a family history of psychiatric illness were significantly associated with postinjury psychiatric outcomes. Interventions for patients with postinjury psychiatric outcomes included pharmacological therapy alone in 2 patients (10%), cognitive behavioral therapy alone in 4 (20%), multimodal therapy in 9 (45%), and no treatment in 5 (25%). Overall, 5 (25%) of the patients with postinjury psychiatric disorders were medically cleared to return to full sports participation, whereas 5 (25%) were lost to follow-up and 9 (45%) remained in treatment by the multidisciplinary concussion program at the end of the study period. One patient who was asymptomatic at the time of initial consultation committed suicide. conclusions Emotiona...

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 95%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Psychiatric outcomes after pediatric sports-related concussion

Ellis

Ritchie

Koltek

et al. 2015

PED

167

142

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Psychological Aspects in Sport Concussions

Slobounov

Walter

2020

Handbook of Sport Psychology

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Integrated care to address child and adolescent health in the 21st century: A clinical review

et al. 2021

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Background Increasing specialisation and technical sophistication of medical tools across the 21st century have contributed to dramatic improvements in the life‐expectancy of children and adolescents with complex physical health problems. Concurrently, there is growing appreciation within the community of the extent that children and adolescents experience mental disorders, which are more prevalent in those with complex chronic, serious or life‐limiting health conditions. In this context, there are compelling reasons for paediatric services to move to a model of care that promotes greater integration of child psychiatry within the medical, somatic teams that care for children and adolescents in children’s hospitals. Aims In this article, we discuss the range of medical disorders managed by contemporary paediatrics. Materials and Methods We conducted a broad review of the literature and existing services, and use individual accounts to illustrate adolescents’ healthcare preferences in the context of the challenges they experience around their mental health. Results Relevant disorders include life‐limiting disorders, such as cancer; disorders involving the brain, such as epilepsy; common chronic disorders, such as asthma and diabetes; psychiatric emergencies, such as deliberate self‐harm; and conditions that most commonly present to paediatric services, but where psychiatric input is required, such as severe eating disorders, somatic symptom disorders and gender dysphoria. The persisting legacy of the historical separation of physical and mental health services is described. Yet there are many models of service integration that can promote more collaborative care between psychiatrists and medical specialists, including some which have been taken to scale. Discussion In essence, clinical teams in children’s hospitals require more collaborative approaches that facilitate early recognition and treatment of the psychological aspects of illness as an integral part of patient‐centred, family‐focussed paediatric care, rather than as something that is bolted on when things go wrong. Conclusion Whilst trust and goodwill between services and providers will be required for novel models of care to be implemented, evaluation of these new models and incorporation of young people’s healthcare preferences is needed.

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Neuropsychiatry of Pediatric Traumatic Brain Injury

Cited by 49 publications

References 96 publications

Psychiatric outcomes after pediatric sports-related concussion

Psychiatric outcomes after pediatric sports-related concussion

Psychological Aspects in Sport Concussions

Integrated care to address child and adolescent health in the 21st century: A clinical review

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