The post-traumatic syndrome: An iatrogenic disease

Kelly, Reginald

doi:10.1016/0300-9432(75)90219-8

Cited by 61 publications

(12 citation statements)

References 3 publications

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“…Two of the three retrospective studies considered a control group in the form of ‘little/no treatment’35 or outcomes in those treated before a change in treatment was implemented 36. Both concluded a benefit.…”

Section: Resultsmentioning

confidence: 99%

Psychological approaches to treatment of postconcussion syndrome: a systematic review

Sayegh

Sandford

Carson

2010

Journal of Neurology, Neurosurgery & Psychiatry

180

109

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Background and aim Postconcussion syndrome (PCS) is a term used to describe the complex, and controversial, constellation of physical, cognitive and emotional symptoms associated with mild brain injury. At the current time, there is a lack of clear, evidence-based treatment strategies. In this systematic review, the authors aimed to evaluate the potential efficacy of cognitive behavioural therapy (CBT) and other psychological treatments in postconcussion symptoms. Methods Four electronic databases were searched up to November 2008 for studies of psychological approaches to treatment or prevention of postconcussion syndrome or symptoms. Results The search identified 7763 citations, and 42 studies were included. This paper reports the results of 17 randomised controlled trials for psychological interventions which fell into four categories: CBT for PCS or specific PCS symptoms; information, reassurance and education; rehabilitation with a psychotherapeutic element and mindfulness/relaxation. Due to heterogeneity of methodology and outcome measures, a meta-analysis was not possible. The largest limitation to our findings was the lack of high-quality studies.

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Section: Resultsmentioning

confidence: 99%

Psychological approaches to treatment of postconcussion syndrome: a systematic review

Sayegh

Sandford

Carson

2010

Journal of Neurology, Neurosurgery & Psychiatry

180

109

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“…Other treatment interventions, including medication, hypnosis, biofeedback, systematic desensitization and cognitive retraining also have limited clinical utility [119][120][121][122]. Kelly [123] observed that post-concussional symptom rates were higher when patients were given no explanation for their symptoms. Minderhoud et al [124] gave patients a manual that contained information about the nature, causes and expected course of recovery, advising that any symptoms could be expected to attenuate and gradually remit after an initial period of rest followed by gradual resumption of work or school.…”

Section: Iatrogenic Influencesmentioning

confidence: 97%

Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome

2004

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Opinions about persisting post-concussional symptoms after minor traumatic brain injury still reflect a polarization of views around the sterile debate concerning the psychological vs organic origins of symptoms. Reviews of the experimental literature do not always integrate the often diverse perspectives that explain persisting symptoms of concussion. As a result, the disorder is still poorly understood. In this review, a diasthesis-stress paradigm examines the interaction between physiological and psychological factors that generate and maintain post-concussional symptoms. Motivational factors and different coping strategies are considered to explain why some people are at risk of developing a post-concussional syndrome. The early iatrogenic potential of GPs and hospital doctors who may create insecurity or reinforce illness perceptions is considered. Finally, the rationale and effectiveness of interventions that ameliorate the impact of early post-concussional symptoms is reviewed to see if prevention of the post-concussional syndrome is more effective than cure.

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“…However, they could be regarded as a refusal of treatment. Brain-injured patients may refuse treatment due to beliefs that brain injury is not curable and/or that brain-injured persons could be regarded as insane 13) . Characteristics as seen in the DEC3 group may also be caused by a decrease in self-awareness and self-perception abilities, a disagreement between patient and spouse (patients may be mainly concerned with physical rehabilitation, while spouses are concerned about all affected functions, including physical, psychological, and cognitive).…”

Section: Discussionmentioning

confidence: 99%

Development of a Cognitive Level Explanation Model in Brain Injury : Comparisons between Disability and Non-Disability Evaluation Groups

Shin

Gong

Kim

et al. 2010

J Korean Neurosurg Soc

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Objective :We investigated whether Disability Evaluation (DE) situations influence patients' neuropsychological test performances and psychopathological characteristics and which variable play a role to establish an explanation model using statistical analysis. Methods : Patients were 536 (56.6%) brain-injured persons who met inclusion and exclusion criteria, classified into the DE group (DE; n = 300, 56.0%) and the non-DE group (NDE; n = 236, 44.0%) according to the neuropsychological testing's purpose. Next, we classified DE subjects into DE cluster 1 (DEC1; 91, 17.0%), DE cluster 2 (DEC2; 125; 23.3%), and DE cluster 3 (DEC3; 84, 15.7%) via two-step cluster analysis, to specify DE characteristics. All patients completed the K-WAIS, K-MAS, K-BNT, SCL-90-R, and MMPI. Results : In comparisons between DE and NDE, the DE group showed lower intelligence quotients and more severe psychopathologic symptoms, as evaluated by the SCL-90-R and MMPI, than the NDE group did. When comparing the intelligence among the DE groups and NDE group, DEC1 group performed worst on intelligence and memory and had most severe psychopathologic symptoms than the NDE group did. The DEC2 group showed modest performance increase over the DEC1 and DEC3, similar to the NDE group. Paradoxically, the DEC3 group performed better than the NDE group did on all variables. Conclusion : The DE group showed minimal "faking bad" patterns. When we divided the DE group into three groups, the DEC1 group showed typical malingering patterns, the DEC2 group showed passive malingering patterns, and the DEC3 group suggested denial of symptoms and resistance to treatment. KEY WORDS :Disability evaluation˙ Brain injury˙ Malingering.

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The post-traumatic syndrome: An iatrogenic disease

Cited by 61 publications

References 3 publications

Psychological approaches to treatment of postconcussion syndrome: a systematic review

Psychological approaches to treatment of postconcussion syndrome: a systematic review

Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome

Development of a Cognitive Level Explanation Model in Brain Injury : Comparisons between Disability and Non-Disability Evaluation Groups

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