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Post-traumatic stress disorder symptoms seen in military patients with concussions
Researchers advised surgeons to consider PTSD symptoms in concussed patients.
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Military personnel who sustain concussions, also referred to as mild traumatic brain injuries, may also show symptoms of post-traumatic stress disorder, according to University of Pittsburgh researchers.
In a large-scale study that included 22,203 participants from the U.S. Army Special Operations Command,
Compared to participants without a history of mTBI, those with an mTBI caused by blast injury had a 4.23 times higher risk of noting PTSD symptoms; those with mTBI from blunt trauma showed a 3.58 higher risk and those with blunt-blast combination mTBIs had a 5.73 times higher rate. Successive blasts also increased the risk for PTSD symptoms, researchers noted.
“From a clinical perspective, the findings suggest that a large percentage of soldiers with a history of diagnosed blast and combination mTBIs and those with higher exposure to blast mTBIs report clinical levels of PTSD,” Kontos told Orthopedics Today. “The results also provided tentative support for subtle cognitive differences among several of the exposure groups in the study. Identification of mTBI and associated clinical outcomes, including development of clinical and sub-clinical PTSD symptoms based on the mechanism of injury or exposure gradient, is critical for awareness and the development of optimal clinical practice guidelines and future treatment pathways.”
Kontos, an assistant research director for the University of Pittsburgh Medical Center Sports Medicine Concussion Program, presented the study results at the Military Health System Research Symposium in Fort Lauderdale, Fla.
Anthony P. Kontos
Screening for brain injuries
The investigators also found that the odds for reporting clinical symptoms for PTSD increased 3.7 times, 4.8 times and 6.4 times from a single blast/combination mTBI to three mTBIs, respectively compared to those without an mTBI.
Kontos said that the dose-response relationship indicates the lasting effects of trauma. “Many soldiers with orthopedic injuries following a blast injury or blunt trauma may also have an mTBI,” he said. “As such, orthopedic surgeons treating these soldiers should screen for mTBI using a combination of clinical exams, symptom reports and neurocognitive tests. Given the importance of the mechanism of injury to the residual effects, soldiers exposed to blast or combination injuries in particular, should be screened for PTSD symptoms and referred for appropriate mental health treatment as indicated.”
Minimize future complications
Patients with PTSD often suffer from symptoms such as hyper vigilance, recurrent thoughts or dreams and anxiety related to certain stressful events.
“Good clinical assessment of both PTSD and mTBI is imperative for proper identification, education and treatment to maximize a soldier’s adaptive combat stress behavior and minimize the possibility of developing dysfunctional behavior related to mTBI and PTSD, even if a soldier’s PTSD levels are below clinical cut-offs,” Kontos said.
Kontos and colleagues are working on two new projects involving the risk factors for mTBI and PTSD, such as age, previous mTBIs, history of migraines, deployment length, years in service and combat exposure. The researchers also plan on examining acute and sub-acute neurocognitive deficits and PTSD symptoms from blast and blunt trauma. – by Jeff Craven
Disclosure: The study was funded by the U.S. Special Operations Command Biomedical Initiatives Steering Committee.