Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T13:59:23.757Z Has data issue: false hasContentIssue false
  • English
  • Français

Postconcussive Complaints, Cognition, Symptom Attribution and Effort among Veterans

Published online by Cambridge University Press:  12 November 2012

Eric B. Larson ,
Bethany R. Kondiles ,
Christine R. Starr  and
Felise S. Zollman
Eric B. Larson*
Affiliation:
Brain Injury Medicine and Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, Illinois Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Bethany R. Kondiles
Affiliation:
Brain Injury Medicine and Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, Illinois
Christine R. Starr
Affiliation:
Brain Injury Medicine and Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, Illinois
Felise S. Zollman
Affiliation:
Department of Neurology, NorthShore University Health System, Glenview, Illinois
*
Correspondence and reprint requests to: Eric Larson, Rehabilitation Institute of Chicago, Brain Injury Medicine and Rehabilitation Program, 345 E. Superior Street, Chicago, IL 60611. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The etiology of postconcussive symptoms is not clearly understood. Development of etiological models of those symptoms will be helpful for accurate diagnosis and for planning effective treatment. Such a model should characterize the role of subject characteristics (education, premorbid intelligence), social psychological factors and symptom validity. Toward that end, the present study examined the association of postconcussive complaints and cognitive performance with symptom attribution and level of effort on testing. In a sample of 155 veterans, attribution to concussion was associated with endorsement of more severe postconcussive complaints, after controlling for the effects of other factors such as subject characteristics. Similarly, effort was associated with cognitive performance after controlling for the effects of these other factors. The present findings are consistent with previous reports that illness perception and effort on testing are associated with postconcussive complaints. This supports previous recommendations to routinely educate all concussion patients immediately after injury to reduce distorted perceptions and related persistent complaints. Finally, these findings highlight a need for routine assessment of patients’ perception of their injury to identify cases that may require psychotherapy to address any misattributions that develop. (JINS, 2013, 19, 1–8)

Keywords

Postconcussion syndromeBrain concussion – diagnosisBrain concussion – complicationsNeuropsychological tests – methodsDiagnosis threatSymptom attribution
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 19 , Issue 1 , January 2013 , pp. 88 - 95
Copyright
Copyright © The International Neuropsychological Society 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Task Force on DSM-IV. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Barker, M.D., Horner, M.D., Bachman, D.L. (2010). Embedded indices of effort in the repeatable battery for the assessment of neuropsychological status (RBANS) in a geriatric sample. The Clinical Neuropsychologist, 24(6), 1064–1077. doi:10.1080/13854046.2010.486009CrossRefGoogle Scholar
Chan, R.C. (2005). How severe should symptoms be before someone is said to be suffering from post-concussion syndrome? An exploratory study with self-reported checklist using Rasch analysis. Brain Injury, 19(13), 1117–1124. doi:10.1080/026990500150088CrossRefGoogle Scholar
Corrigan, J.D., Bogner, J. (2007a). Initial reliability and validity of the Ohio State University TBI identification method. Journal of Head Trauma Rehabilitation, 22(6), 318–329. doi:10.1097/01.HTR.0000300227.67748.77CrossRefGoogle ScholarPubMed
Corrigan, J.D., Bogner, J. (2007b). Screening and identification of TBI. Journal of Head Trauma Rehabilitation, 22(6), 315–317.CrossRefGoogle ScholarPubMed
Fenton, G., McClelland, R., Montgomery, A., MacFlynn, G., Rutherford, W. (1993). The postconcussional syndrome: Social antecedents and psychological sequelae. British Journal of Psychiatry, 162, 493–497.CrossRefGoogle ScholarPubMed
Gunstad, J., Suhr, J.A. (2002). Perception of illness: Nonspecificity of postconcussion syndrome symptom expectation. Journal of the International Neuropsychological Society, 8(1), 37–47.CrossRefGoogle ScholarPubMed
Hoge, C.W., Goldberg, H.M., Castro, C.A. (2009). Care of war veterans with mild traumatic brain injury--flawed perspectives. New England Journal of Medicine, 360(16), 1588–1591. doi:360/16/1588CrossRefGoogle ScholarPubMed
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., Castro, C.A. (2008). Mild traumatic brain injury in U.S. Soldiers returning from Iraq. New England Journal of Medicine, 358(5), 453–463. doi:10.1056/NEJMoa072972CrossRefGoogle ScholarPubMed
Iverson, G.L. (2005). Outcome from mild traumatic brain injury. Current Opinion in Psychiatry, 18(3), 301–317. doi:10.1097/01.yco.0000165601.29047.ae 00001504-200505000-00013CrossRefGoogle ScholarPubMed
Iverson, G.L. (2006). Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Archives of Clinical Neuropsychology, 21(4), 303–310. doi:10.1016/j.acn.2005.12.008CrossRefGoogle ScholarPubMed
Iverson, G.L., Lange, R.T. (2003). Examination of “postconcussion-like” symptoms in a healthy sample. Applied Neuropsychology, 10(3), 137–144. doi:10.1207/S15324826AN1003_02CrossRefGoogle Scholar
Iverson, G.L., Zasler, N.D., Lange, R.T. (2007). Post-concussive disorder. In N. D. Zasler, D. I. Katz, & R. D. Zafonte (Eds.), Brain injury medicine: Principles and practice. New York: Demos.Google Scholar
King, N.S., Crawford, S., Wenden, F.J., Moss, N.E., Wade, D.T. (1995). The Rivermead Post Concussion Symptoms Questionnaire: A measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242(9), 587–592.CrossRefGoogle ScholarPubMed
Lannsjo, M., af Geijerstam, J.L., Johansson, U., Bring, J., Borg, J. (2009). Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort. Brain Injury, 23(3), 213–219. doi:10.1080/02699050902748356CrossRefGoogle Scholar
Larson, E., Kondiles, B., Zollman, F.S. (2011). Memory, postconcussion disorder and posttraumatic stress disorder in a volunteer sample of veterans. Chicago, IL: Rehabilitation Institute of Chicago.Google Scholar
Mittenberg, W., Canyock, E.M., Condit, D., Patton, C. (2001). Treatment of post-concussion syndrome following mild head injury. Journal of Clinical and Experimental Neuropsychology, 23(6), 829–836. doi:10.1076/jcen.23.6.829.1022CrossRefGoogle ScholarPubMed
Mittenberg, W., DiGiulio, D.V., Perrin, S., Bass, A.E. (1992). Symptoms following mild head injury: Expectation as aetiology. Journal of Neurology, Neurosurgery, and Psychiatry, 55(3), 200–204.CrossRefGoogle ScholarPubMed
Mittenberg, W., Patton, C., Canyock, E.M., Condit, D.C. (2002). Base rates of malingering and symptom exaggeration. Journal of Clinical and Experimental Neuropsychology, 24(8), 1094–1102. doi:10.1076/jcen.24.8.1094.8379CrossRefGoogle ScholarPubMed
Moser, R.S., Schatz, P. (2002). Enduring effects of concussion in youth athletes. Archives of Clinical Neuropsychology, 17(1), 91–100. doi:S0887617701001081 [pii]CrossRefGoogle ScholarPubMed
Nelson, N.W., Hoelzle, J.B., McGuire, K.A., Ferrier-Auerbach, A.G., Charlesworth, M.J., Sponheim, S.R. (2010). Evaluation context impacts neuropsychological performance of OEF/OIF veterans with reported combat-related concussion. Archives of Clinical Neuropsychology, 25(8), 713–723. doi:10.1093/arclin/acq075CrossRefGoogle ScholarPubMed
Nelson, N.W., Hoelzle, J.B., McGuire, K.A., Sim, A.H., Goldman, D.J., Ferrier-Auerbach, A.G., Sponheim, S.R. (2011). Self-report of psychological function among OEF/OIF personnel who also report combat-related concussion. The Clinical Neuropsychologist, 25(5), 716–740. doi:10.1080/13854046.2011.579174CrossRefGoogle ScholarPubMed
Randolph, C. (1998). Repeatable battery for the assessment of neuropsychological status manual. San Antonio, TX: The Psychological Corporation.Google Scholar
Resnick, P.J. (1997). Malingering of post-traumatic disorders. In R. Rogers (Ed.), Clinical assessment of malingering and deception (2nd Ed., pp. 130–152). New York: Guilford.Google Scholar
Rief, W., Broadbent, E. (2007). Explaining medically unexplained symptoms-models and mechanisms. Clin Psychol Rev, 27(7), 821–841. doi:10.1016/j.cpr.2007.07.005CrossRefGoogle ScholarPubMed
Santa Maria, M.P., Pinkston, J.B., Miller, S.R., Gouvier, W.D. (2001). Stability of postconcussion symptomatology differs between high and low responders and by gender but not by mild head injury status. Archives of Clinical Neuropsychology, 16(2), 133–140.CrossRefGoogle Scholar
Schretlen, D.J., Shapiro, A.M. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychology, 15(4), 341–349. doi:10.1080/09540260310001606728CrossRefGoogle ScholarPubMed
Silverberg, N.D., Wertheimer, J.C., Fichtenberg, N.L. (2007). An effort index for the Repeatable Battery For The Assessment Of Neuropsychological Status (RBANS). The Clinical Neuropsychologist, 21(5), 841–854. doi:769512323CrossRefGoogle ScholarPubMed
Snell, D.L., Siegert, R.J., Hay-Smith, E.J.C., Surgenor, L.J. (2011). Associations between illness perceptions, coping styles and outcome after mild traumatic brain injury: Preliminary results from a cohort study. Brain Injury, 25(11), 1126–1138. doi:10.3109/02699052.2011.607786CrossRefGoogle ScholarPubMed
Snell, D.L., Surgenor, L.J., Hay-Smith, E.J., Siegert, R.J. (2009). A systematic review of psychological treatments for mild traumatic brain injury: An update on the evidence. Journal of Clinical and Experimental Neuropsychology, 31(1), 20–38. doi:10.1080/13803390801978849CrossRefGoogle ScholarPubMed
Suhr, J.A., Gunstad, J. (2002). “Diagnosis Threat”: The effect of negative expectations on cognitive performance in head injury. Journal of Clinical and Experimental Neuropsychology, 24(4), 448–457. doi:10.1076/jcen.24.4.448.1039CrossRefGoogle ScholarPubMed
Tanielian, T.L., Jaycox, L., & Rand Corporation. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND.Google Scholar
Vanderploeg, R.D., Curtiss, G., Belanger, H.G. (2005). Long-term neuropsychological outcomes following mild traumatic brain injury. Journal of the International Neuropsychological Society, 11(3), 228–236. doi:10.1017/S1355617705050289CrossRefGoogle ScholarPubMed
Wechsler, D. (2001). Wechsler Test of Adult Reading (WTAR). San Antonio, TX: The Psychological Corporation.Google Scholar
Whittaker, R., Kemp, S., House, A. (2007). Illness perceptions and outcome in mild head injury: A longitudinal study. Journal of Neurology, Neurosurgery, and Psychiatry, 78(6), 644–646. doi:10.1136/jnnp.2006.101105CrossRefGoogle ScholarPubMed
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar