The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk

Legarreta, Andrew D.; Brett, Benjamin L.; Solomon, Gary S.; Zuckerman, Scott L.

doi:10.3171/2018.3.peds1850

Cited by 38 publications

(28 citation statements)

References 42 publications

(58 reference statements)

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“…However, we cannot conclude whether each condition contributes to the overall effect in a unique manner, or whether the effect is largely mediated by an individual mental health condition. Our findings align with prior work that have established ADD/ADHD [17], depression [10,12], and migraine [20] as conditions often comorbid with anxiety disorders. This suggests that pre-injury anxiety may be one of many potential factors that contribute to prolonged recovery.…”

Section: Discussionsupporting

confidence: 91%

“…The independent effect of pre-injury anxiety disorders on concussion recovery cannot be determined solely by our study, due to limitations in the sensitivity of our anxiety measures. Prior work further supports this notion by establishing a connection between pre-existing psychiatric conditions -including depression and ADD/ ADHD -and prolonged recovery [11,12,14]. This suggests that although pre-existing anxiety disorders are not independently predictive of prolonged recovery or balance problems, patients with a pre-existing anxiety disorder are more likely to have comorbid conditions which together may lead to prolonged recovery and balance dysfunction.…”

Section: Variablementioning

confidence: 92%

“…Quantifying levels of anxiety would allow for evaluation of a doseresponse effect between levels of pre-existing anxiety and postconcussion symptoms and recovery times. Knowledge about the independent effect of anxiety disorders on concussion symptoms allows for more insight on the potential mechanisms underlying the previously established prolonged recovery associated with preexisting mood disorders [11][12][13][14][15].…”

Section: Variablementioning

confidence: 99%

“…Additionally, psychiatric history, including a diagnosis of a preexisting anxiety disorder, has been examined as a potential risk factor for prolonged recovery [11][12][13][14]. Two studies have investigated the role of pre-existing anxiety within recovery, finding that preinjury anxiety is associated with longer time to full clearance, and a non-significant association with prolonged symptom duration ( > 28 days) [7,15].…”

Section: Introductionmentioning

confidence: 99%

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Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

et al. 2020

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Our purpose was to evaluate the effect of self-reported pre-injury anxiety diagnosis on persistent symptom development, vestibular symptom severity, and balance control among youth who sustained a concussion. We performed a retrospective study of patients seen at a specialty pediatric concussion clinic. Patients were 18 years of age or younger, examined within 10 days of concussion, and received care until full recovery. A questionnaire was used to assess pre-existing medical and psychiatric conditions, including anxiety. Our main outcomes were prolonged symptom recovery defined as persistent symptoms for > 28 days after concussion) and severity of vestibular symptoms. Patients who reported pre-injury anxiety (n=43; median age=14.9 years; 37% female) were more likely to experience symptoms>28 days post-injury (76 vs. 54%; p=0.04) than those without pre-existing anxiety (n=241; median age=14.9 years; 53% female). After adjusting for sex, history of migraine, depression and ADHD, however, there was no independent association between pre-existing anxiety and prolonged symptom duration (adjusted odds ratio=2.34; 95% CI=0.083–6.63; p=0.11). Pre-existing anxiety was independently associated with self-reported nausea/vomiting severity (β coefficient=0.59, 95% CI=0.07–1.11). A pre-existing anxiety diagnosis does not appear to be associated with persistent symptoms after concussion, although it may be associated with post-injury nausea.

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Section: Discussionsupporting

confidence: 91%

Section: Variablementioning

confidence: 92%

Section: Variablementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

et al. 2020

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“…Pre-injury mental health problems, such as depression and anxiety, are a risk factor for persistent symptoms following MTBI (21, 36, 109–112). Depression is common following TBIs of all severities (113–115).…”

Section: Network Analysis In Psychiatry and Psychologymentioning

confidence: 99%

Network Analysis and Precision Rehabilitation for the Post-concussion Syndrome

Iverson

2019

Front. Neurol.

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Some people experience persistent symptoms following a mild traumatic brain injury (MTBI), and the etiology of those symptoms has been debated for generations. Post-concussion-like symptoms are caused by many factors both before and after MTBI, and this non-specificity is the bedrock of the conundrum regarding the existence of the post-concussion syndrome. A latent model or common cause theory for the syndrome is inconsistent with the prevailing biopsychosocial conceptualization. It is the thesis of this paper that adopting a network perspective for persistent symptoms following MTBI, including the post-concussion syndrome, could lead to new insights and targeted treatment and rehabilitation strategies. The network perspective posits that symptoms co-occur because they are strongly inter-related, activating, amplifying, and mutually reinforcing, not because they arise from a common latent disease entity. This approach requires a conceptual shift away from thinking that symptoms reflect an underlying disease or disorder toward viewing inter-related symptoms as constituting the syndrome or disorder. The symptoms do not arise from an underlying syndrome—the symptoms are the syndrome. A network analysis approach allows us to embrace heterogeneity and comorbidity, and it might lead to the identification of new approaches to sequenced care. The promise of precision rehabilitation requires us to better understand the interconnections among symptoms and problems so that we can produce more individualized and effective treatment and rehabilitation.

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Sport‐Related Traumatic Brain Injury

Ahluwalia

Mummareddy

Bonfield

et al. 2020

Encyclopedia of Life Sciences

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Sport‐related traumatic brain injury (SRTBI) is a disease process with a high incidence, complex pathophysiology and heterogeneous outcomes. SRTBI is generally dichotomised into sport‐related concussion (SRC) and sport‐related structural brain injury (SRSBI). A variety of sporting events can lead to these injuries. The diagnosis of SRC relies on sound clinical judgment, although multiple adjuncts have been investigated. Prompt diagnosis is essential for the management of all SRTBI, and it is critical to differentiate SRC from a potential SRSBI. Depending on the specific SRTBI, a variety of treatment options are available ranging from conservative rehabilitation to, rarely, prompt neurosurgical intervention. Finally, clinical outcomes are inherently linked to the nature of the injury and vary from full recovery to patient death. Given the high incidence, importance of prompt diagnosis and heterogeneous outcomes, SRTBI is an essential topic not only for clinicians and researchers but also for athletes, parents, coaching staff and officials. Key Concepts Sport‐related concussion (SRC) has a high incidence and is largely differentiated from other SRTBI by negative neuroimaging. Sport‐related structural brain injury has positive neuroimaging and is typically diagnosed with a noncontrast computed tomography (CT) scan of the head. Second‐impact syndrome is exceedingly rare, but the associated high risk of morbidity remains a relevant driving force for SRC management. Diagnosis of SRC remains clinical with sideline tools as adjuncts including but not limited to SCAT5, King‐Devick, and Sway. Clinical judgment and evaluation supersede all concussion assessment tools. Recovery from SRC usually occurs within 14–28 days, and no focal neurologic deficit is expected. Post‐concussive syndrome is commonly defined as the presence of concussive symptomatology for greater than 4 weeks. The outcome of SRSBI is highly variable and dependent on the nature of the intracranial injury.

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The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk

Cited by 38 publications

References 42 publications

Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

Network Analysis and Precision Rehabilitation for the Post-concussion Syndrome

Sport‐Related Traumatic Brain Injury

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