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The role of early posttraumatic neuropsychological outcomes in the appearance of latter psychiatric disorders in adults with brain trauma.

Yousefzadeh-Chabok S, Ramezani S, Reihanian Z, Safaei M, Alijani B, Amini N - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: There was no significant difference between groups regarding functional outcome at discharge.Diffuse axonal injury (12.96%) and hemorrhages (40.74%) within the cortex (42.59%) and sub-cortex (33.33) significantly occurred more prevalent in PTPD group than non-PTPD ones.Hence, early combined therapeutic supplies including neuroprotective pharmacotherapy and neurofeedback for neural function reorganization can dampen the lesion expansion and latter PTPD.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran.

ABSTRACT

Background: The objective was to determine the predictors of posttraumatic psychiatric disorders (PTPD) during the first 6 months following traumatic brain injury (TBI) focusing on neuroimaging, clinical and neuropsychological appraisements during acute and discharge phase of TBI.

Materials and methods: We designed a prospective, longitudinal study in which 150 eligible TBI patients were entered. Postresuscitation brain injury severity and discharged functional outcome were evaluated by standard clinical scales. First neuroimaging was done at a maximum of 24 h after head trauma. Early posttraumatic (PT) neuropsychological outcomes were assessed using Persian neuropsychological tasks at discharge. The standardized psychiatric assessments were carefully implemented 6 months postinjury. A total of 133 patients returned for follow-up assessment at 6 months. They were divided into two groups according to the presence of PTPD.

Results: Apparently, aggression was the most prevalent type of PTPD (31.48%). There was no significant difference between groups regarding functional outcome at discharge. Diffuse axonal injury (12.96%) and hemorrhages (40.74%) within the cortex (42.59%) and sub-cortex (33.33) significantly occurred more prevalent in PTPD group than non-PTPD ones. Primary postresuscitation TBI severity, early PT lingual deficit and subcortical lesion on first scan were able to predict PTPD at 6 months follow-up.

Conclusion: Almost certainly, the expansive dissociation risk of cortical and subcortical pathways related to linguistic deficits due to severe intracranial lesions over a period of time can augment possibility of subsequent conscious cognitive-emotional processing deficit, which probably contributes to latter PTPD. Hence, early combined therapeutic supplies including neuroprotective pharmacotherapy and neurofeedback for neural function reorganization can dampen the lesion expansion and latter PTPD.

No MeSH data available.


Related in: MedlinePlus

Distribution of posttraumatic psychiatric disorder types in traumatic brain injury adults at 6 months after injury
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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Figure 1: Distribution of posttraumatic psychiatric disorder types in traumatic brain injury adults at 6 months after injury

Mentions: There was 11.3% dropout of initial sampling. 17 patients discontinued this research, 4 people due to death and 13 ones because of unwillingness. Analyses were carried out for 133 participants who returned for follow-up assessments at 6 months after injury. Figure 1 illustrates the distribution of PTPD types in participants of this study during first 6 months postinjury. Apparently, aggression was the most prevalent type of PTPD (31.48%). The percentage of patients who faced Apathy at 6 months follow-up was dramatically 25.92%. In individuals with latter PTPD, depression (20.37%) and posttraumatic stress disorder (PTSD) (16.66%) were observed 6 months following TBI. Almost 11% of PTPD cases exhibited other types of PTPD including psychotic syndrome (1.85%), obsessive-compulsive disorder (OCD) (1.85%), generalized anxiety disorder (7.4%). Sexual (9.25%) and sleep (1.85%) disorders were also reported as medical conditions co-occurred to aggression and depression respectively. According to Table 1, results of univariate analysis indicated that there was a significant association between latter PTPD and the followings; lesion type (P < 0.012), lesion site (P < 0.001) and postresuscitation TBI severity (P < 0.004). Neuroimaging results in PTPD patients predominantly displayed intracranial lesions in cortex (42.59%) and sub-cortex (33.33%), whereas meninges (69.62%) were prevalently injured in patients without PTPD. In PTPD group, hematoma (40.74%) and DAI (17.96%) were significantly more common lesion types than non-PTPD ones. Based on primary postresuscitation GCS, severe TBI category was signalized significantly in the PTPD versus the non-PTPD group. No significant association was witnessed between latter PTPD incidence and age (P < 0.802), gender (P < 0.913), education status (P < 0.543), etiology of TBI (P < 0.711). Moreover, functional outcome at discharge (P < 0.493), lesion side (P < 0.999) and family psychiatric history (P < 0.234) were not significantly related to latter PTPD occurrence in the first 6 months after injury. More details are represented in Table 1. Tables 2 and 3 illustrate the results of statistical analysis of PT neuropsychological and psychiatric outcomes in patients with several TBI types and locations. According to theses tables were revealed that several TBI groups were significantly different in respect to Executive function (P < 0.002), verbal memory (P < 0.01), PT lingual dysfunction (P < 0.03) and PTPD (P < 0.02). Scheffe post-hoc test demonstrated that executive function score was significantly different between DAI group and other ones (P < 0.001), as well as between Pneumocephalus and other ones (P < 0.001). Hematoma (P < 0.002) and DAI (P < 0.001) groups significantly performed verbal memory task poorer than Edema, contusion, and Pneumocephalus. There was a significant difference among TBI types groups regarding the PT lingual dysfunction (P < 0.03) and PTPD (P < 0.02). On the other hand, all DAI patients demonstrated PT lingual dysfunctions and psychiatric disorders. Patients suffered pneumocephalus had the lowest percentage of PT lingual dysfunctions and PTPD among TBI types groups. It was also revealed that TBI patients with several lesion locations indicated significant difference in terms of the executive functions (P < 0.002), verbal memory (P < 0.01), PT lingual dysfunction (P < 0.003) and PTPD (P < 0.002). Post-hoc analysis results signified that patients with meninges lesion performed executive functions task significantly better than patients with cortical (P < 0.004), subcortical (P < 0.004) and brain stem (P < 0.002) lesions. TBI patients with impaired ventricles acquired higher executive functions score rather than cortical (P < 0.003), subcortical (P < 0.002) and brain stem (P < 0.002) lesions groups. Patients are having cortical lesions significantly exhibited poor performance in the verbal memory task versus patients with ventricle (P < 0.02), meninges (P < 0.001) and brain stem (P < 0.04) lesions. Verbal memory score in subcortical lesion group was significantly lower than subjects with ventricle (P < 0.01), meninges (P < 0.001) and brain stem (P < 0.03) lesions. Moreover, it was discovered that appearance probability of PT lingual dysfunction (P < 0.003) and PTPD (P < 0.002) in patients with cortical and subcortical lesions was more than other ones. The results of statistical analyses to explore the association between latter PTPD appearance and early PT neuropsychological outcomes were summed in Table 4, highlighting the insignificant difference between TBI patients with PTPD and without PTPD in terms of the visual memory function (P < 0.201) and presence of perceptual dysfunction (P < 0.097) at discharge. Two groups were performed significantly different in verbal memory (P < 0.025) and executive functions (P < 0.005) tasks. In other words, PTPD group obtained lower scores for the executive function, verbal memory tasks than non-PTPD group. Similarly, subjects who had early PT lingual dysfunction were also significantly more likely at risk of the latter PTPD. We entered all above significant variables (P < 0.1) in the multiple logistic regression [Table 5]. In the final modeling processing step, postresuscitation TBI severity and exist of early PT lingual dysfunction at discharge, as well as subcortical lesion on scan at first 24 h after injury were the variables, which remained in the final model and hence we can consider them as predictors of PTPD 6 months after TBI onset. Namely, brain injury severity was the first powerful significant predictor of latter PTPD (odds ratio [OR] = 0.54; confidence interval [CI] 95% = 0.09–1.03). It was followed by early PT lingual dysfunction as second (OR = 0.71; CI 95% = 0.1–1.8) and sub-cortex lesion as third (OR = 0.92; CI 95% = 0.57–1.95) strong significant predictors to anticipate PTPD at 6 months after TBI. PTPD was not predicted by other variables included in the regression model.


The role of early posttraumatic neuropsychological outcomes in the appearance of latter psychiatric disorders in adults with brain trauma.

Yousefzadeh-Chabok S, Ramezani S, Reihanian Z, Safaei M, Alijani B, Amini N - Asian J Neurosurg (2015 Jul-Sep)

Distribution of posttraumatic psychiatric disorder types in traumatic brain injury adults at 6 months after injury
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553728&req=5

Figure 1: Distribution of posttraumatic psychiatric disorder types in traumatic brain injury adults at 6 months after injury
Mentions: There was 11.3% dropout of initial sampling. 17 patients discontinued this research, 4 people due to death and 13 ones because of unwillingness. Analyses were carried out for 133 participants who returned for follow-up assessments at 6 months after injury. Figure 1 illustrates the distribution of PTPD types in participants of this study during first 6 months postinjury. Apparently, aggression was the most prevalent type of PTPD (31.48%). The percentage of patients who faced Apathy at 6 months follow-up was dramatically 25.92%. In individuals with latter PTPD, depression (20.37%) and posttraumatic stress disorder (PTSD) (16.66%) were observed 6 months following TBI. Almost 11% of PTPD cases exhibited other types of PTPD including psychotic syndrome (1.85%), obsessive-compulsive disorder (OCD) (1.85%), generalized anxiety disorder (7.4%). Sexual (9.25%) and sleep (1.85%) disorders were also reported as medical conditions co-occurred to aggression and depression respectively. According to Table 1, results of univariate analysis indicated that there was a significant association between latter PTPD and the followings; lesion type (P < 0.012), lesion site (P < 0.001) and postresuscitation TBI severity (P < 0.004). Neuroimaging results in PTPD patients predominantly displayed intracranial lesions in cortex (42.59%) and sub-cortex (33.33%), whereas meninges (69.62%) were prevalently injured in patients without PTPD. In PTPD group, hematoma (40.74%) and DAI (17.96%) were significantly more common lesion types than non-PTPD ones. Based on primary postresuscitation GCS, severe TBI category was signalized significantly in the PTPD versus the non-PTPD group. No significant association was witnessed between latter PTPD incidence and age (P < 0.802), gender (P < 0.913), education status (P < 0.543), etiology of TBI (P < 0.711). Moreover, functional outcome at discharge (P < 0.493), lesion side (P < 0.999) and family psychiatric history (P < 0.234) were not significantly related to latter PTPD occurrence in the first 6 months after injury. More details are represented in Table 1. Tables 2 and 3 illustrate the results of statistical analysis of PT neuropsychological and psychiatric outcomes in patients with several TBI types and locations. According to theses tables were revealed that several TBI groups were significantly different in respect to Executive function (P < 0.002), verbal memory (P < 0.01), PT lingual dysfunction (P < 0.03) and PTPD (P < 0.02). Scheffe post-hoc test demonstrated that executive function score was significantly different between DAI group and other ones (P < 0.001), as well as between Pneumocephalus and other ones (P < 0.001). Hematoma (P < 0.002) and DAI (P < 0.001) groups significantly performed verbal memory task poorer than Edema, contusion, and Pneumocephalus. There was a significant difference among TBI types groups regarding the PT lingual dysfunction (P < 0.03) and PTPD (P < 0.02). On the other hand, all DAI patients demonstrated PT lingual dysfunctions and psychiatric disorders. Patients suffered pneumocephalus had the lowest percentage of PT lingual dysfunctions and PTPD among TBI types groups. It was also revealed that TBI patients with several lesion locations indicated significant difference in terms of the executive functions (P < 0.002), verbal memory (P < 0.01), PT lingual dysfunction (P < 0.003) and PTPD (P < 0.002). Post-hoc analysis results signified that patients with meninges lesion performed executive functions task significantly better than patients with cortical (P < 0.004), subcortical (P < 0.004) and brain stem (P < 0.002) lesions. TBI patients with impaired ventricles acquired higher executive functions score rather than cortical (P < 0.003), subcortical (P < 0.002) and brain stem (P < 0.002) lesions groups. Patients are having cortical lesions significantly exhibited poor performance in the verbal memory task versus patients with ventricle (P < 0.02), meninges (P < 0.001) and brain stem (P < 0.04) lesions. Verbal memory score in subcortical lesion group was significantly lower than subjects with ventricle (P < 0.01), meninges (P < 0.001) and brain stem (P < 0.03) lesions. Moreover, it was discovered that appearance probability of PT lingual dysfunction (P < 0.003) and PTPD (P < 0.002) in patients with cortical and subcortical lesions was more than other ones. The results of statistical analyses to explore the association between latter PTPD appearance and early PT neuropsychological outcomes were summed in Table 4, highlighting the insignificant difference between TBI patients with PTPD and without PTPD in terms of the visual memory function (P < 0.201) and presence of perceptual dysfunction (P < 0.097) at discharge. Two groups were performed significantly different in verbal memory (P < 0.025) and executive functions (P < 0.005) tasks. In other words, PTPD group obtained lower scores for the executive function, verbal memory tasks than non-PTPD group. Similarly, subjects who had early PT lingual dysfunction were also significantly more likely at risk of the latter PTPD. We entered all above significant variables (P < 0.1) in the multiple logistic regression [Table 5]. In the final modeling processing step, postresuscitation TBI severity and exist of early PT lingual dysfunction at discharge, as well as subcortical lesion on scan at first 24 h after injury were the variables, which remained in the final model and hence we can consider them as predictors of PTPD 6 months after TBI onset. Namely, brain injury severity was the first powerful significant predictor of latter PTPD (odds ratio [OR] = 0.54; confidence interval [CI] 95% = 0.09–1.03). It was followed by early PT lingual dysfunction as second (OR = 0.71; CI 95% = 0.1–1.8) and sub-cortex lesion as third (OR = 0.92; CI 95% = 0.57–1.95) strong significant predictors to anticipate PTPD at 6 months after TBI. PTPD was not predicted by other variables included in the regression model.

Bottom Line: There was no significant difference between groups regarding functional outcome at discharge.Diffuse axonal injury (12.96%) and hemorrhages (40.74%) within the cortex (42.59%) and sub-cortex (33.33) significantly occurred more prevalent in PTPD group than non-PTPD ones.Hence, early combined therapeutic supplies including neuroprotective pharmacotherapy and neurofeedback for neural function reorganization can dampen the lesion expansion and latter PTPD.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran.

ABSTRACT

Background: The objective was to determine the predictors of posttraumatic psychiatric disorders (PTPD) during the first 6 months following traumatic brain injury (TBI) focusing on neuroimaging, clinical and neuropsychological appraisements during acute and discharge phase of TBI.

Materials and methods: We designed a prospective, longitudinal study in which 150 eligible TBI patients were entered. Postresuscitation brain injury severity and discharged functional outcome were evaluated by standard clinical scales. First neuroimaging was done at a maximum of 24 h after head trauma. Early posttraumatic (PT) neuropsychological outcomes were assessed using Persian neuropsychological tasks at discharge. The standardized psychiatric assessments were carefully implemented 6 months postinjury. A total of 133 patients returned for follow-up assessment at 6 months. They were divided into two groups according to the presence of PTPD.

Results: Apparently, aggression was the most prevalent type of PTPD (31.48%). There was no significant difference between groups regarding functional outcome at discharge. Diffuse axonal injury (12.96%) and hemorrhages (40.74%) within the cortex (42.59%) and sub-cortex (33.33) significantly occurred more prevalent in PTPD group than non-PTPD ones. Primary postresuscitation TBI severity, early PT lingual deficit and subcortical lesion on first scan were able to predict PTPD at 6 months follow-up.

Conclusion: Almost certainly, the expansive dissociation risk of cortical and subcortical pathways related to linguistic deficits due to severe intracranial lesions over a period of time can augment possibility of subsequent conscious cognitive-emotional processing deficit, which probably contributes to latter PTPD. Hence, early combined therapeutic supplies including neuroprotective pharmacotherapy and neurofeedback for neural function reorganization can dampen the lesion expansion and latter PTPD.

No MeSH data available.


Related in: MedlinePlus