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The relationship of psychological and cognitive factors and opioids in the development of the postconcussion syndrome in general trauma patients with mild traumatic brain injury

Published online by Cambridge University Press:  25 October 2006

SUSANNE MEARES ,
E. ARTHUR SHORES ,
JENNIFER BATCHELOR ,
IAN J. BAGULEY ,
JENNIFER CHAPMAN ,
JOSEPH GURKA  and
JENO E. MAROSSZEKY
SUSANNE MEARES
Affiliation:
Department of Psychology, Macquarie University, New South Wales, Australia
E. ARTHUR SHORES
Affiliation:
Department of Psychology, Macquarie University, New South Wales, Australia
JENNIFER BATCHELOR
Affiliation:
Department of Psychology, Macquarie University, New South Wales, Australia
IAN J. BAGULEY
Affiliation:
Department of Rehabilitation Medicine, Westmead Hospital, New South Wales, Australia
JENNIFER CHAPMAN
Affiliation:
Department of Rehabilitation Medicine, Westmead Hospital, New South Wales, Australia
JOSEPH GURKA
Affiliation:
Department of Rehabilitation Medicine, Westmead Hospital, New South Wales, Australia
JENO E. MAROSSZEKY
Affiliation:
Department of Rehabilitation Medicine, Westmead Hospital, New South Wales, Australia
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Abstract

The relationship of psychological and cognitive factors in the development of the postconcussion syndrome (PCS) following mild uncomplicated traumatic brain injury (mTBI) has received little study. This may be because of the widely held belief that neurological factors are the cause of early PCS symptoms, whereas psychological factors are responsible for enduring symptoms. To further understand these relationships, the association between PCS and neuropsychological and psychological outcome was investigated in 122 general trauma patients, many of whom had orthopedic injuries, around 5 days following mTBI. Apart from verbal fluency, participants with a PCS did not differ in their performances on neuropsychological measures compared to those without a PCS. Individuals with a PCS reported significantly more psychological symptoms. Large effect sizes present on the psychological measures showed that the difference between participants with a PCS and without was greater on psychological than on neuropsychological measures. Analyses also revealed a relationship between opioid analgesia and depression, anxiety and stress, and opioids and reduced learning. The results suggest that psychological factors are present much earlier than has previously been considered in the development of the PCS. (JINS, 2006, 12, 792–801.)

Keywords

Brain concussionHead injuryMinorNeuropsychologicalAcute Stress DisorderNarcotic
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 12 , Issue 6 , November 2006 , pp. 792 - 801
Copyright
© 2006 The International Neuropsychological Society

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References

REFERENCES

Alexander, M.P. (1995). Mild traumatic brain injury: Pathophysiology, natural history, and clinical management. Neurology, 45, 1253–1260.CrossRefGoogle Scholar
American Congress of Rehabilitation Medicine. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8, 86–87.Google Scholar
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
Axelrod, B.N., Fox, D.D., Lees-Haley, P.R., Earnest, K., & Dolezal-Wood, S. (1998). Application of the Postconcussive Syndrome Questionnaire with medical and psychiatric outpatients. Archives of Clinical Neuropsychology, 13, 543–548.CrossRefGoogle Scholar
Axelrod, B.N., Fox, D.D., Lees-Haley, P.R., Earnest, K., Dolezal-Wood, S., & Goldman, R.S. (1996). Latent structure of the Postconcussion Syndrome Questionnaire. Psychological Assessment, 8, 422–427.Google Scholar
Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., & Monteiro, M.G. (2001). AUDIT—The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care (2nd ed.). Geneva: World Health Organization.
Barona, A. & Chastain, R.L. (1986). An improved estimate of premorbid IQ for blacks and whites on the WAIS-R. International Journal of Clinical Neuropsychology, 8, 169–173.Google Scholar
Belanger, H.G., Curtiss, G., Demery, J.A., Lebowitz, B.K., & Vanderploeg, R.D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of the International Neuropsychological Society, 11, 215–227.Google Scholar
Binder, L.M. (1986). Persisting symptoms after mild head injury: A review of the postconcussive syndrome. Journal of Clinical and Experimental Neuropsychology, 8, 323–346.CrossRefGoogle Scholar
Binder, L.M. (1997). A review of mild head trauma. Part II: Clinical Implications. Journal of Clinical and Experimental Neuropsychology, 19, 432–457.Google Scholar
Boake, C., McCauley, S.R., Levin, H.S., Contant, C.F., Song, J.X., Brown, S.A., Goodman, H.S., Brundage, S.I., Diaz-Marchan, P.J., & Merritt, S.G. (2004). Limited agreement between criteria-based diagnoses of postconcussional syndrome. The Journal of Neuropsychiatry and Clinical Neurosciences, 16, 493–499.CrossRefGoogle Scholar
Bohnen, N., Twijnstra, A., & Jolles, J. (1992). Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury. Brain Injury, 6, 481–487.Google Scholar
Bohnen, N., Twijnstra, A., Kroeze, J., & Jolles, J. (1991). A psychophysical method for assessing visual and acoustic hyperaesthesia in patients with mild head injury. British Journal of Psychiatry, 159, 860–863.CrossRefGoogle Scholar
Bryant, R.A. & Harvey, A.G. (1999). The influence of traumatic brain injury on acute stress disorder and post-traumatic stress disorder following motor vehicle accidents. Brain Injury, 13, 15–22.CrossRefGoogle Scholar
Bryant, R.A., Moulds, M.L., & Guthrie, R.M. (2000). Acute Stress Disorder Scale: A self-report measure of acute stress disorder. Psychological Assessment, 12, 61–68.CrossRefGoogle Scholar
Carroll, L.J., Cassidy, J.D., Holm, L., Kraus, J.F., & Coronado, V. (2004a). Methodological issues and research recommendations for mild traumatic brain injury: The WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 36, Suppl. 43, 113–125.Google Scholar
Carroll, L.J., Cassidy, J.D., Peloso, P.M., Borg, J., von Holst, H., Holm, L., Paniak, C., & Pepin, M. (2004b). Prognosis for mild traumatic brain injury: Results of the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 36, Suppl. 43, 84–105.Google Scholar
Cartlidge, N.E.F., & Shaw, D.A., with a contribution by Kalbag, R.M. (1981). Head Injury. London: W.B. Saunders Company Ltd.
Cattelani, R., Gugliotta, M., Maravita, A., & Mazzucchi, A. (1996). Post-concussive syndrome: Paraclinical signs, subjective symptoms, cognitive functions and MMPI profiles. Brain Injury, 10, 187–195.CrossRefGoogle Scholar
Cicerone, K.D. & Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 10, 1–17.CrossRefGoogle Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.CrossRefGoogle Scholar
Collins, M.W., Field, M., Lovell, M.R., Iverson, G., Johnston, K.M., Maroon, J., & Fu, F.H. (2003). Relationship between postconcussion headache and neuropsychological test performance in high school athletes. American Journal of Sports Medicine, 31, 168–173.CrossRefGoogle Scholar
Dikmen, S., Machamer, J., & Temkin, N. (2001). Mild head injury: Facts and artifacts. Journal of Clinical and Experimental Neuropsychology, 23, 729–738.CrossRefGoogle Scholar
Dubois, B., Slachvesky, A., Litvan, I., & Pillon, B. (2000). The FAB: A frontal assessment battery at bedside. Neurology, 55, 1621–1626.CrossRefGoogle Scholar
Evans, R.W. (1994). The postconcussion syndrome: 130 years of controversy. Seminars in Neurology, 14, 32–39.CrossRefGoogle Scholar
Forrester, G., Encel, J., & Geffen, G. (1994). Measuring post-traumatic amnesia (PTA): An historical review. Brain Injury, 8, 175–184.CrossRefGoogle Scholar
Gasquoine, P.G. (1997). Postconcussion symptoms. Neuropsychology Review, 7, 77–85.CrossRefGoogle Scholar
Gouvier, W.D., Cubic, B., Jones, G., Brantley, P., & Cutlip, Q. (1992). Postconcussion symptoms and daily stress in normal and head-injured college populations. Archives of Clinical Neuropsychology, 7, 193–211.CrossRefGoogle Scholar
Gouvier, W.D., Uddo-Crane, M., & Brown, L.M. (1988). Base rates of post-concussional symptoms. Archives of Clinical Neuropsychology, 3, 273–278.CrossRefGoogle Scholar
Grigsby, J. & Kaye, K. (1993). Incidence and correlates of depersonalization following head trauma. Brain Injury, 7, 507–513.CrossRefGoogle Scholar
Gronwall, D. & Wrightson, P. (1980). Duration of post-traumatic amnesia after mild head injury. Journal of Clinical Neuropsychology, 2, 51–60.CrossRefGoogle Scholar
Harvey, A.G. & Bryant, R.A. (1998). Acute stress disorder after mild traumatic brain injury. The Journal of Nervous and Mental Disease, 186, 333–337.CrossRefGoogle Scholar
Hinton-Bayre, A.D., Geffen, G., & McFarland, K. (1997). Mild head injury and speed of information processing: A prospective study of professional rugby league players. Journal of Clinical and Experimental Neuropsychology, 19, 275–289.CrossRefGoogle Scholar
Horn, G.J. (1996). A comparative and factor analytic investigation of Post Concussion Syndrome. Dissertation Abstracts International, 56, 4583.Google Scholar
Iverson, G.L. (2005). Outcome from mild traumatic brain injury. Current Opinion in Psychiatry, 18, 301–317.CrossRefGoogle Scholar
Iverson, G.L., Gaetz, M., Lovell, M.R., & Collins, M.W. (2004). Relation between subjective fogginess and neuropsychological testing following concussion. Journal of the International Neuropsychological Society, 10, 904–906.Google Scholar
Iverson, G.L. & McCracken, L.M. (1997). ‘Postconcussive’ symptoms in persons with chronic pain. Brain Injury, 11, 783–790.CrossRefGoogle Scholar
Jensen, M.P. & Karoly, P. (2001). Self-report procedures for assessing pain in adults. In D.C. Turk & R. Melzack (Eds.), Handbook of Pain Assessment in Adults. New York: Guildford Press.
Jones, C., Harvey, A.G., & Brewin, C.R. (2005). Traumatic brain injury, dissociation, and posttraumatic stress disorder in road traffic accident survivors. Journal of Traumatic Stress, 18, 181–191.CrossRefGoogle Scholar
Kaoua, B.N., Veron, A.-L.H., Lespinet, V.C., Claverie, B., & Sztark, F. (2002). Time course of cognitive recovery after propofol anaesthesia: A level of processing approach. Journal of Clinical and Experimental Neuropsychology, 24, 713–719.CrossRefGoogle Scholar
Karzmark, P., Hall, K., & Englander, J. (1995). Late-onset post-concussion symptoms after mild brain injury: The role of premorbid, injury-related, environmental, and personality factors. Brain Injury, 9, 21–26.CrossRefGoogle Scholar
Kashluba, S., Casey, J.E., & Paniak, C. (2006). Evaluating the utility of ICD-10 diagnostic criteria for postconcussion syndrome following mild traumatic brain injury. Journal of the International Neuropsychological Society, 12, 111–118.Google Scholar
Kay, T., Cavallo, M.M., Ezrachi, O., & Vavagiakis, P. (1995). The Head Injury Family Interview: A clinical and research tool. Journal of Head Trauma Rehabilitation, 10, 12–31.CrossRefGoogle Scholar
King, N.S. (1996). Emotional, neuropsychological, and organic factors: Their use in the prediction of persisting postconcussion symptoms after moderate and mild head injuries. Journal of Neurology, Neurosurgery, and Psychiatry, 61, 75–81.Google Scholar
King, N.S., Crawford, S., Wenden, F.J., Moss, N.E.G., & 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, 587–592.CrossRefGoogle Scholar
Levin, H.S., Gary, H.E., High, W.M., Mattis, S., Ruff, R.M., Eisenberg, H.M., Marshall, L.F., & Tabaddor, K. (1987a). Minor head injury and the postconcussional syndrome: Methodological issues in outcome studies. In H.S. Levin, J. Grafman, & H.M. Eisenberg (Eds.), Neurobehavioral Recovery from Head Injury. New York: Oxford University Press.
Levin, H.S., Mattis, S., Ruff, R.M., Eisenberg, H.M., Marshall, L.F., Tabaddor, K., High, W.M., Jr., & Frankowski, R.F. (1987b). Neurobehavioral outcome following minor head injury: A three-center study. Journal of Neurosurgery, 66, 234–243.Google Scholar
Levin, H.S., O'Donnell, V.M., & Grossman, R.G. (1979). The Galveston Orientation and Amnesia Test: A practical scale to assess cognition after head injury. The Journal of Nervous and Mental Disease, 167, 675–684.CrossRefGoogle Scholar
Lidvall, H.F., Linderoth, B., & Norlin, B. (1974). Causes of the post-concussional syndrome. Acta Neurologica Scandinavica, 50, Suppl. 56, 1–144.Google Scholar
Lishman, W.A. (1988). Physiogenesis and psychogenesis in the “Post-Concussional Syndrome.” British Journal of Psychiatry, 153, 460–469.CrossRefGoogle Scholar
Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney, Australia: The Psychology Foundation of Australia Inc.
Luis, C.A., Vanderploeg, R.D., & Curtiss, G. (2003). Predictors of postconcussion symptom complex in community dwelling male veterans. Journal of the International Neuropsychological Society, 9, 1001–1015.Google Scholar
MacFlynn, G., Montgomery, E.A., Fenton, G.W., & Rutherford, W. (1984). Measurement of reaction time following minor head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 47, 1326–1331.CrossRefGoogle Scholar
McAllister, T.W., Saykin, A.J., Flashman, L.A., Spartlin, M.B., Johnson, S.C., Guerin, S.J., Mamourian, A.C., Weaver, J.B., & Yanofsky, N. (1999). Brain activation during working memory 1 month after mild traumatic brain injury: A functional MRI study. Neurology, 53, 1300–1308.Google Scholar
McCauley, S.R., Boake, C., Levin, H.S., Contant, C.F., & Song, J.X. (2001a). Postconcussional disorder following mild to moderate traumatic brain injury: Anxiety, depression and social support as risk factors and comorbidities. Journal of Clinical and Experimental Neuropsychology, 23, 792–808.Google Scholar
McCauley, S.R., Levin, H.S., Vanier, M., Mazaux, J-M., Boake, C., Goldfader, P.R., Rockers, D., Butters, M., Kareken, D.A., Lambert, J., & Clifton, G.L. (2001b). The neurobehavioural rating scale-revised: Sensitivity and validity in closed head injury assessment. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 643–651.Google Scholar
Miller, E.N. (1999). CALCAP—California Computerized Assessment Package Manual. USA: Erin N. Miller and Norland Software.
Mittenberg, W. & Strauman, S. (2000). Diagnosis of mild head injury and the postconcussion syndrome. Journal of Head Trauma Rehabilitation, 15, 783–791.CrossRefGoogle Scholar
O'Donnell, M.L., Creamer, M., Bryant, R.A., Schnyder, U., & Shalev, A. (2003). Posttraumatic disorders following injury: an empirical and methodological review. Clinical Psychology Review, 23, 587–603.CrossRefGoogle Scholar
Ponsford, J. & Kinsella, G. (1992). Attentional deficits following closed-head injury. Journal of Clinical and Experimental Neuropsychology, 14, 822–838.CrossRefGoogle Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A.-M., Nelms, R., Curran, C., & Ng, K. (2000). Factors influencing outcome following mild traumatic brain injury in adults. Journal of the International Neuropsychological Society, 6, 568–579.Google Scholar
Raskin, S., Mateer, C., & Tweeten, R. (1998). Neuropsychological evaluation of mild traumatic brain injury. The Clinical Neuropsychologist, 12, 21–30.CrossRefGoogle Scholar
Rutherford, W.H. (1989). Postconcussion symptoms: Relationship to acute neurological indices, individual differences, and circumstances of injury. In H.S. Levin, H.M. Eisenberg, & A.L. Benton (Eds.), Mild Head Injury. New York: Oxford University Press.
Shores, E.A. (1995). Further concurrent validity data on the Westmead PTA scale. Applied Neuropsychology, 2, 167–169.Google Scholar
Shores, E.A., Marosszeky, J.E., Sandanam, J., & Batchelor, J. (1986). Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. The Medical Journal of Australia, 144, 569–572.Google Scholar
Smith, A. (1982). Symbol Digit Modalities Test Manual. Los Angeles: Western Psychological Services.
Spreen, O. & Strauss, E. (1998). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary (2nd ed). New York: Oxford University Press.
Strauss, I. & Savitsky, N. (1934). Head injury: Neurologic and psychiatric aspects. Archives of Neurology and Psychiatry, 31, 893–955.CrossRefGoogle Scholar
Suhr, J.A. & Gunstad, J. (2002). Postconcussive symptom report: The relative influence of head injury and depression. Journal of Clinical and Experimental Neuropsychology, 24, 981–993.CrossRefGoogle Scholar
van Zomeran, A. & van den Burg, W. (1985). Residual complaints of patients two years after severe head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 48, 21–28.CrossRefGoogle Scholar
Waddell, P.A. & Gronwall, D.M.A. (1984). Sensitivity to light and sound following minor head injury. Acta Neurologica Scandinavia, 69, 270–276.CrossRefGoogle Scholar
Waterloo, K., Ingebrigtsen, T., & Romner, B. (1997). Neuropsychological function in patients with increased serum levels of Protein S-100 after minor head injury. Acta Neurochirurgica, 139, 26–32.CrossRefGoogle Scholar
World Health Organization. (1993). The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.
Williams, D.H., Levin, H.S., & Eisenberg, H.M. (1990). Mild head injury classification. Neurosurgery, 27, 422–428.Google Scholar
Wrightson, P. & Gronwall, D. (1981). Time off work and symptoms after minor head injury. Injury, 12, 445–454.CrossRefGoogle Scholar
Zacny, J.P. (1995). A review of the effects of opioids on psychomotor and cognitive functioning in humans. Experimental and Clinical Psychopharmacology, 3, 432–466.CrossRefGoogle Scholar
Zakzanis, K.K. (2001). Statistics to tell the truth, the whole truth, and nothing but the truth: Formulae, illustrative numerical examples, and heuristic interpretation of effect size analyses for neuropsychological researchers. Archives of Clinical Neuropsychology, 16, 653–667.CrossRefGoogle Scholar
Zakzanis, K.K., Leach, L., & Kaplan, E. (1999). Neuropsychological Differential Diagnosis. Lisse, Switzerland: Swets & Zeitlinger.