Review: Managing Posttraumatic Stress Disorder in Combat Veterans With Comorbid Traumatic Brain Injury

Capehart, Bruce P.; Bass, David

doi:10.1176/appi.focus.11.3.396

Cited by 10 publications

(9 citation statements)

References 159 publications

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“…Yin et al ( 2011 ) also showed that patients with PTSD had reduced spontaneous activity in the cerebellum. While concurrent diagnoses of mTBI and PTSD are difficult due to common symptoms and problems with self-report assessments (Capehart and Bass, 2012 ), there may still be relatively high rates of PTSD within the population of patients who have experienced mTBI (Hoge et al, 2008 ; Rosenfeld and Ford, 2010 ; Graner et al, 2013 ). In our study, reduced spontaneous cerebellar activity in acute mTBI patients may subserve cognitive and emotional impairment disorders.…”

Section: Discussionmentioning

confidence: 99%

Amplitude of Low-Frequency Fluctuations in Multiple-Frequency Bands in Acute Mild Traumatic Brain Injury

Zhan

Gao

Zhou

et al. 2016

Front. Hum. Neurosci.

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Functional disconnectivity during the resting state has been observed in mild traumatic brain injury (mTBI) patients during the acute stage. However, it remains largely unknown whether the abnormalities are related to specific frequency bands of the low-frequency oscillations (LFO). Here, we used the amplitude of low-frequency fluctuations (ALFF) to examine the amplitudes of LFO in different frequency bands (slow-5: 0.01–0.027 Hz; slow-4: 0.027–0.073 Hz; and typical: 0.01–0.08 Hz) in patients with acute mTBI. A total of 24 acute mTBI patients and 24 age-, sex-, and education-matched healthy controls participated in this study. In the typical band, acute mTBI patients showed lower standardized ALFF in the right middle frontal gyrus and higher standardized ALFF in the right lingual/fusiform gyrus and left middle occipital gyrus. Further analyses showed that the difference between groups was concentrated in a narrower (slow-4) frequency band. In the slow-5 band, mTBI patients only exhibited higher standardized ALFF in the occipital areas. No significant correlation between the mini-mental state examination score and the standardized ALFF value was found in any brain region in the three frequency bands. Finally, no significant interaction between frequency bands and groups was found in any brain region. We concluded that the abnormality of spontaneous brain activity in acute mTBI patients existed in the frontal lobe as well as in distributed brain regions associated with integrative, sensory, and emotional roles, and the abnormal spontaneous neuronal activity in different brain regions could be better detected by the slow-4 band. These findings might contribute to a better understanding of local neural psychopathology of acute mTBI. Future studies should take the frequency bands into account when measuring intrinsic brain activity of mTBI patients.

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Section: Discussionmentioning

confidence: 99%

Amplitude of Low-Frequency Fluctuations in Multiple-Frequency Bands in Acute Mild Traumatic Brain Injury

Zhan

Gao

Zhou

et al. 2016

Front. Hum. Neurosci.

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“…Blast-related mTBI appears to increase the risk of post-traumatic stress disorder (PTSD) with a substantial overlap between mTBI and PTSD issues ( 3 , 4 ). Military deployments to Afghanistan and Iraq have been associated with an elevated prevalence of both PTSD and mTBI among combat veterans ( 5 – 7 ) The diagnosis and management of PTSD when a comorbid mTBI may also exist presents a challenge to interdisciplinary care teams at the Department of Veterans Affairs (VA) and civilian medical facilities, particularly when the patient reports a history of blast exposure ( 8 ). From a treatment perspective, trauma-focused cognitive behavioral therapy (TF-CBT) is the therapy that is associated with superior improvement in PTSD symptoms and psychosocial outcome in mTBI survivors ( 9 ) with a slight advantage compared to all other treatments ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Effectiveness of a Novel Brain and Vestibular Rehabilitation Treatment Modality in PTSD Patients Who have Suffered Combat-Related Traumatic Brain Injuries

Frederick

McLellan

Brock

et al. 2015

Front. Public Health

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Introduction: Blast-related head injuries are among the most prevalent injuries suffered by military personnel deployed in combat and mild traumatic brain injury (mTBI) or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a “signature injury.” Vestibular complaints are the most frequent sequelae of mTBI, and vestibular rehabilitation (VR) has been established as the most important treatment modality for this group of patients.Materials and Methods: We studied the effectiveness of a novel brain and VR treatment post-traumatic stress disorder (PTSD) in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as Identifier: NCT02003352. (). We analyzed the difference in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores pre- and post-treatment using our subjects as their own matched controls. The study population consisted of 98 combat veterans maintaining an alpha of <0.05 and power of 80%.Results: Prior to treatment, 75 subjects representing 76.53 % of the sample were classified in the 2 most severe categories of PTSD. Forty-one subjects, representing 41.80 % of the total sample, were classified in the extreme category of PTSD and 34 subjects, representing 34.70 % of the total sample, were classified in the severe category of PTSD. After treatment, we observed a large reduction in CAPS severity scores with both statistical and substantive significance.Discussion: Treatment of PTSD as a physical injury rather than a psychiatric disorder is associated with strong statistical and substantive significant outcomes associated with a decrease of PTSD classification. The stigma associated with neuropsychiatric disorders may be lessened when PTSD is treated with brain and VR with a potential decrease in suffering of patients, family, and society.

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“…34 Capehart and Bass reviewed the Department of Defense/ Veteran's Affairs Clinical Practice Guideline (VA/DoD CPG) for the Management of PTSD in the context of treatment of comorbid TBI. 62 First-line recommendations were sertraline and citalopram. Second-line choices included fluoxetine, mirtazapine, or nefazodone.…”

Section: Behavioral Interventionsmentioning

confidence: 99%

Neuropsychiatric Disturbances Associated with Traumatic Brain Injury: A Practical Approach to Evaluation and Management

et al. 2015

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Traumatic brain injury (TBI) causes a wide variety of neuropsychiatric disturbances associated with great functional impairments and low quality of life. These disturbances include disorders of mood, behavior, and cognition, and changes in personality. The diagnosis of specific neuropsychiatric disturbances can be difficult because there is significant symptom overlap. Systematic clinical evaluations are necessary to make the diagnosis and formulate a treatment plan that often requires a multipronged approach. Management of TBI-associated neuropsychiatric disorders should always include nonpharmacological interventions, including education, family involvement, supportive and behavioral psychotherapies, and cognitive rehabilitation. Pharmacological treatments include antidepressants, anticonvulsants, antipsychotics, dopaminergic agents, and cholinesterase inhibitors. However, evidence-based treatments are extremely limited, and management relies on clinical empiricism and resemblance of TBI neuropsychiatric symptom profiles with those of idiopathic psychiatric disorders. Although the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed including prospective, longitudinal studies to explore biomarkers that will assist with management and prognosis as well as randomized-controlled studies to validate pharmacological and nonpharmacological treatments. The current review summarizes the available literature in support of a structured, systematic evaluation approach and treatment options as well as recommendations for further research directions.

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Review: Managing Posttraumatic Stress Disorder in Combat Veterans With Comorbid Traumatic Brain Injury

Cited by 10 publications

References 159 publications

Amplitude of Low-Frequency Fluctuations in Multiple-Frequency Bands in Acute Mild Traumatic Brain Injury

Amplitude of Low-Frequency Fluctuations in Multiple-Frequency Bands in Acute Mild Traumatic Brain Injury

Evaluation of the Effectiveness of a Novel Brain and Vestibular Rehabilitation Treatment Modality in PTSD Patients Who have Suffered Combat-Related Traumatic Brain Injuries

Neuropsychiatric Disturbances Associated with Traumatic Brain Injury: A Practical Approach to Evaluation and Management

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