Psychiatric outcomes after pediatric sports-related concussion

Abstract

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...

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

“…In rare cases, patients with vestibulo-ocular and cervicogenic PCD can experience mild exacerbation of their symptoms that typically occurs towards the later stages of exercise when walking at higher inclines. In some cases, PCS patients may develop clinical features that meet the International Classification of Headache Disease 3beta (ICHD-3B) criteria for new or worsening migraine headaches (83), while others may develop post-injury psychiatric outcomes including mood disorders (84). Although some patients will demonstrate symptoms of multiple or overlapping PCDs, the following classification system provides a conceptual framework that allows physicians to identify the pathophysiological mechanisms that govern persistent concussion symptoms and informs the development of individually tailored rehabilitation programs (see Tables 1 and 2; Figure 1).…”

Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach

“…41 To date, the majority of published case reports on the retirement decision-making process in the setting of multiple concussions and prolonged recovery are limited to discussions regarding collegiate and professional athletes.…”

Longitudinal trajectories of post-concussive and depressive symptoms in adolescents with prolonged recovery from concussion

“…14 Furthermore, acquired psychological symptoms commonly occur following injury. 15 Particular attention has been paid to the prevalence of depressive symptoms that co-occur with other persistent post-concussive symptoms. A study of previously healthy adults without psychiatric pre-morbidities at time of study enrollment who sustained mild traumatic brain injury indicated that 62.5% of patients with persistent post-concussive symptoms 1 year after injury had a modifiable psychological risk factor (i.e., depression, possible PTSD, and/or low resilience) at 1 month.…”

“…26 While it is accepted that a relationship exists between depressive and persistent post-concussive symptoms, it remains poorly understood how depressive symptoms change over time in conjunction with post-concussive symptoms in patients who are slow to recover from concussion, as there is little research in this area, and none focused on youth. 14,15,27–29 To our knowledge, no previous study has prospectively assessed longitudinal trajectories of post-concussive and depressive symptoms in a pediatric population of patients who remain symptomatic from concussion after the acute recovery period.…”