摘要:

Objective:To examine the structure of persistent postconcussive symptoms in a sample of patients with mild traumatic brain injury.Design:Multivariate discriminant analysis in a series of 50 consecutive clinical referrals evaluated for postconcussive symptoms, neuropsychological functioning, and personality and emotional functioning at least 3 months after injury; follow‐up information regarding level of disability was obtained for 37 patients at least 1 year after injury.Setting:Neuropsychology clinic affiliated with a comprehensive brain trauma rehabilitation center.Patients:50 consecutively referred patients with a diagnosis of mild traumatic brain injury referred by physicians, rehabilitation nurses, or attorneys because of persistent deficits or subjective complaints consistent with a postconcussion syndrome.Main Outcome Measure:Postconcussive symptoms endorsed on the Post Mild Traumatic Brain Injury Symptom Checklist.Results:Four factors consisting of multiple symptoms were identified: cognitive factor, affective factor, somatic factor, and sensory factor. Using these four factors, K‐means cluster analysis of subjects was applied to classify patients. Patient clusters consisted of those with minimal symptoms, those with primarily cognitive‐affective symptoms, those with prominent somatic symptoms, and those with severe global symptoms (P = .000). Patient symptom clusters were largely unrelated to neurological or neuropsychological functioning. The presence of chronic disability and resumption of productive functioning differed significantly among groups (P = .003).Conclusions:Subjective complaints provide clinically meaningful information and are strongly related to the nature and extent of disability after mild traumatic brain injury. Characterization of a single postconcussive syndrome may be misleading, and it may be more meaningful to define a number of postconcussive syndromes with differing symptom profiles and recovery.

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Objective:To study mild head injury patients with poor psychosocial and vocational outcomes using neurological single photon emission computed tomography (neuroSPECT) imaging.Design:Case‐comparison study.Setting:VA Medical Center, outpatient clinics.Patients:Fourteen mild head injury patients with normal computed tomography (CT) and/or magnetic resonance imaging (MRI) scans and five normal controls. Head‐injured patients were selected because they had obtained and maintained highly responsible employment prior to injury, but were unable to sustain any occupation despite multiple attempts over a number of years after injury.Intervention:NeuroSPECT with technetium Tc 99m hexamethylpropyleneamine oxime.Main Outcome Measure:Regional abnormalities in cerebral perfusion as indicated by neuroSPECT.Results:This carefully preselected population consistently showed anterior mesial temporal hypoperfusion. By contrast, posterior temporal abnormalities were very infrequent. NeuroSPECT findings with regard to orbitofrontal damage were not as striking, but were statistically significant on the left and were sufficient to raise the question of dysfunction in this area as well.Conclusions:Findings indicate that some “mild” head injuries with unusually catastrophic psychosocial consequences can produce regional abnormalities in cerebral perfusion that are apparent with neuroSPECT, even in the absence of abnormalities seen on CT or MRI.

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Objective:Describe the pre‐ and postinjury patterns of alcohol and other drug use among persons who have incurred traumatic brain injury (TBI). Injury‐related characteristics and negative consequences are also reported, as well as preliminary outcomes of treatment.Design:Descriptive analysis of a consecutive sample of persons referred during an 18‐month period to a treatment program for substance abuse after TBI.Setting:A community‐based demonstration project affiliated with an acute rehabilitation hospital in a large midwestern academic medical center.Patients:The first 211 persons screened by the program, including all 97 receiving comprehensive assessments and 68 who dropped out prior to assessment. Preliminary outcomes were based on the first 37 clients monitored 6 months after entering into treatment.Intervention:Screening for appropriateness of referral; comprehensive, holistic assessment; and resource and service coordination provided by an interdisciplinary staff that facilitates treatment by local providers.Main Outcome Measures:Alcohol use measured by the Quantity‐Frequency‐Variability Index, completed by client and significant other; productivity measured by the Employability Rating Scale; multiple sociodemographic indicators.Results:More than 60% of injuries were use related; this included 71% of assaults. Alcohol was the preferred drug for 83%, and more than half used some marijuana. Prior to injury, the study sample consumed significantly greater amounts of alcohol than national averages; after injury, consumption was consistent with national averages. Approximately 20% of individuals who abstained or were light drinkers before injury showed high volume use after injury.Conclusions:There are multiple reasons why the harmful effects of alcohol and other drug use after TBI are underestimated, including cultural acceptance of beer and the subtle sequelae of marijuana use. It is recommended that the extent of use of same‐aged peers not be used as the criterion for acceptable use by persons who have experienced TBI. Further study is needed regarding the utility of assessment devices, the effectiveness of referrals made during rehabilitation, and the efficacy of intervention techniques.

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Objective:To determine the effectiveness of medroxyprogesterone acetate (Depo‐Provera) treatment in conjunction with psychological counseling on the hypersexual behavior seen in individuals with traumatic brain injury.Design:A retrospective review of the use of Depo‐Provera in adult male patients who sustained a traumatic brain injury from blunt trauma and subsequently exhibited hypersexual behavior. All individuals were treated with a combination of weekly Depo‐Provera injections and psychological counseling; the latter was educational/behavioral in nature and took into account such problems as deficits in awareness and empathy, poor memory, concreteness, and rigidity. Follow‐up examinations were done every 3 months for at least 2 years and every 6 months thereafter.Setting:Individuals were seen in outpatient treatment and reside in community environments.Patients:Eight males (average age = 17.5 years at the time of head trauma) who developed problematic hypersexual behavior approximately 3 years later. These individuals were consecutive referrals to a psychiatric practicc with expertise in the treatment of hypersexual behavior.Intervention:Weekly intramuscular Depo‐Provera injections were used in conjunction with counseling.Main Outcome Measures:Incidence of hypersexual behavior; change in testosterone level.Results:In all cases, cessation of the unacceptable sexual behavior was noted while the men received treatment (mean duration = 42 months). Three individuals remain on Depo‐Provera, and two have successfully discontinued treatment for 2 and 10 years, respectively, with no further problems. The remaining three reoffended when medication was discontinued, a decision made unilaterally by their families.Conclusions:The use of Depo‐Provera in conjunction with counseling may offer an opportunity to control aberrant sexual behaviors after brain injury. However, only a minority of individuals stay in good control after discontinuing Depo‐Provera.

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1995

数据来源: OVID