Post-traumatic Confusional State: A Case Definition and Diagnostic Criteria

Abstract

In response to the need to better define the natural history of emerging consciousness after traumatic brain injury and to better describe the characteristics of the condition commonly labeled posttraumatic amnesia, a case definition and diagnostic criteria for the posttraumatic confusional state (PTCS) were developed. This project was completed by the Confusion Workgroup of the American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest group. The case definition was informed by an exhaustive literature review and expert opinion of workgroup members from multiple disciplines. The workgroup reviewed 2466 abstracts and extracted evidence from 44 articles. Consensus was reached through teleconferences, face-to-face meetings, and 3 rounds of modified Delphi voting. The case definition provides detailed description of PTCS (1) core neurobehavioral features, (2) associated neurobehavioral features, (3) functional implications, (4) exclusion criteria, (5) lower boundary, and ( 6) criteria for emergence. Core neurobehavioral features include disturbances of attention, orientation, and memory as well as excessive fluctuation. Associated neurobehavioral features include emotional and behavioral disturbances, sleep-wake cycle disturbance, delusions, perceptual disturbances, and confabulation. The lower boundary distinguishes PTCS from the minimally conscious state, while upper boundary is marked by significant improvement in the 4 core and 5 associated features. Key research goals are establishment of cutoffs on assessment instruments and

A Psychological Portrait of a Teenager in the Posttraumatic Confusional State

“…Состояние спутанности сознания после черепно-мозговых травм не является тождественным состоянию делирия (психическое расстройство с сохраненным осознанием собственной личности), выделяемому в общей психиатрии [11,[14][15][16]. В западной литературе состояние спутанности может звучать как «посттравматическое спутанное состояние сознания» [17][18][19]. В данной статье для обозначения состояния у детей-подростков после травмы мозга, характеризуемого снижением памяти на те-кущие события и дезориентацией в месте, времени и своем состоянии, мы будем использовать термин «посттравматическое спутанное сознание» (posttraumatic confusional state, PTCS), или «состояние спутанности».…”

“…В ряде научных работ, посвященных PTCS, уделяется большое внимание таким психическим процессам, как функции управления, функции программирования, регуляции и контроля, когнитивные функции [17,22,23]. Практически все авторы отмечают у больных в состоянии спутанности сознания повышенную истощаемость [3,11,22,23].…”

“…Выполнение каких-либо просьб или команд возможно только, если это вписывается во «внутреннюю нужду» самого ребенка. Конечно, во многом это связано со снижением возможностей контролирующего эго (снижение функций программирования, регуляции, контроля и управления) [17,22,23]. Более того, определение внутренней нужды часто затруднительно из-за отсутствия в поведении целеполагающей и направленной активности.…”

Systems of Care and Natural History of Traumatic Brain Injury

“…The most widely used is the Rancho Los Amigos levels of cognitive functioning 87 (see Table 1.1). Another schema, fi rst proposed by Alexander 88 and further modifi ed (sometimes referred to as the Braintree scale), 56,65,89 tracks similar stages using more familiar neurological nomenclature, with established diagnostic criteria 90,91 (see Table 1.2). As patients progress through these stages, the principal defi ning cognitive limitations evolve from defi cits in arousal and consciousness, to basic attention and anterograde amnesia, to higher level attention, memory, executive functioning, processing speed, insight, and social awareness.…”

“…Patients with less severe injuries or injuries with predominantly focal injury may not demonstrate recognizable transitions through all of the stages described. 91 The fi rst stage of recovery is coma, a state of unconsciousness without spontaneous eye opening. This corresponds to Rancho level I.…”