PTSD and traumatic brain injury: folklore and fact? Brain Inj

Community Head Injury Service, The Camborne Centre, Bedgrove, Aylesbury, Bucks, UK.
Brain Injury (Impact Factor: 1.86). 02/2008; 22(1):1-5. DOI: 10.1080/02699050701829696
Source: PubMed

ABSTRACT A number of controversies and debates have arisen over the years surrounding the dual diagnosis of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Many of these have centred around the around the degree of protection provided by TBI against developing the disorder. The following is brief review of the literature in this area to help resolve some of these issues and to address a number of specific challenges which arise when working with this patient group.

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    • "It has been proposed that persistent postconcussive symptoms may also be iatrogenic phenomena in some patients (i.e., that diagnosis threat, diagnostic misinformation, or treatment context might contribute to symptom maintenance; Howe, 2009). The interaction between PTSD and history of mTBI has been described as " mutually exacerbating " (King, 2008, p. 3). Extending the notion of mutual symptom exacerbation in PTSD and mTBI, Brenner, Vanderploeg, and Terrio (2009) proposed a model of cumulative disadvantage for understanding the complex clinical presentation and increased risk of poor outcomes when the conditions co-occur. "
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    ABSTRACT: Objective: This retrospective study examined treatment adherence in Cognitive Processing Therapy (CPT) for combat-related posttraumatic stress disorder (PTSD) in Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with and without history of mild traumatic brain injury (mTBI). Method: Medical record review of consecutive referrals to an outpatient PTSD clinic identified veterans diagnosed with combat-related PTSD who began treatment with CPT. The sample (N = 136) was grouped according to positive (n = 44) and negative (n = 92) mTBI history. Groups were compared in terms of presenting symptoms and treatment adherence. Results: The groups were not different on a pretreatment measure of depression, but self-reported and clinician-rated PTSD symptoms were higher in veterans with history of mTBI. The treatment completion rate was greater than 61% in both groups. The number of sessions attended averaged 9.6 for the PTSD group and 7.9 for the mTBI/PTSD group (p = .05). Implications: Given the lack of marked group differences in treatment adherence, these initial findings suggest that standard CPT for PTSD may be a tolerable treatment for OEF/OIF veterans with a history of PTSD and mTBI as well as veterans with PTSD alone. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Rehabilitation Psychology 02/2013; 58(1):36-42. DOI:10.1037/a0031525 · 1.91 Impact Factor
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    ABSTRACT: Analyze the contribution of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) to the endorsement of postconcussive (PC) symptoms during Post Deployment Health Assessment. Determine whether a combination of mTBI and PTSD was more strongly associated with symptoms than either condition alone. Cross-sectional study design where both the exposure, mTBI and/or PTSD, and the outcomes of interest, PC symptoms, were ascertained after return from deployment. Subjects were injured soldiers (n = 1247) from one Fort Carson Brigade Combat Team (n = 3973). Positive history of PC symptoms. PTSD and mTBI together were more strongly associated with having PC symptoms (adjusted prevalence ratio 6.27; 95% CI: 4.13-9.43) than either mTBI alone (adjusted prevalence ratio = 4.03; 95% CI: 2.67-6.07) or PTSD alone (adjusted prevalence ratio = 2.74; 95% CI: 1.58-4.74) after adjusting for age, gender, education, rank, and Military Occupational Specialty. In soldiers with histories of physical injury, mTBI and PTSD were independently associated with PC symptom reporting. Those with both conditions were at greater risk for PC symptoms than those with either PTSD, mTBI, or neither. Findings support the importance of continued screening for both conditions with the aim of early identification and intervention.
    The Journal of head trauma rehabilitation 11/2009; 25(5):307-12. DOI:10.1097/HTR.0b013e3181cada03 · 3.00 Impact Factor
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