A Systematic Review of Anxiety Disorders following Mild, Moderate and Severe TBI in Children and Adolescents

The aim of this chapter is to systematically review the research exploring the relationship between TBI and anxiety disorders in children and adolescents. A literature search was conducted using Google Scholar, Ovid Medline (1946 - Dec 2013), PsycINFO (1806 - Dec 2013), CINAHL plus (1937 - Dec 2013), Cochrane database (2005 – Dec 2013) and Embase (1946 – Dec 2013). The search returned 346 articles, and 11 of these met the inclusion criteria. Anxiety disorders were often found to be a negative outcome following childhood TBI, with a higher incidence of disorders including GAD, ASD, PTSD, PD, OCD, simple/specific phobia, social phobia and SAD found in children following their injury. In most cases, this relationship was strongest for children with severe TBI who sustained their injury at a younger age. Psychosocial adversity was found to be a consistently significant predictor for the likelihood of children developing anxiety following TBI. It is concluded that children who have suffered from a TBI (mild, moderate or severe), are at a higher risk of developing subsequent anxiety disorders, even 1 year following the injury event, and children with more severe injuries, greater psychosocial adversity, and younger age at injury are considered to be the most vulnerable

Mild Traumatic Brain Injury: A Review of Terminology, Symptomatology, Clinical Considerations and Future Directions

Traumatic Brain Injury (TBI) is a leading cause of morbidity and mortality, with estimates of prevalence varying between 100-1000 per 100,000 [1, 2]. Among these figures, 70-90 % will be classified as mild TBI (mTBI) [2]. While only 10 % of those with a history of mTBI will have any ongoing problems [2], the sheer volume of incidents means that these events represent a majo

Long term behavioural, psychiatric and cognitive outcomes following mild head injury in childhood

Mild head injury is generally considered to be a common but benign childhood event. Previous studies investigating potential cognitive and behavioural consequences have produced mixed findings and controversial outcomes, in part due to a number of methodological difficulties. The present study used a longitudinal birth cohort (initiated in 1977) which permitted the use of a fully prospective design. Of the total original cohort of 1265 children, 134 sought medical attention for a mild head injury with confirmed or suspected concussion occurring between birth and ten years of age. The children were grouped into those who received medical attention at an outpatient facility (n = 96) and those who were hospitalised overnight for observation (n = 36). The remainder of the cohort acted as a reference group against which outcomes for the head injured groups were compared. After controlling for a wide range of demographic, family and pre­ injury characteristics, the mild head injury inpatient group but not the outpatient group displayed increased attentional and conduct difficulties, as rated by mothers and teachers. These difficulties were evident over 7-13 years in the inpatient subgroup who experienced an injury between 0-5 years and over 10-13 years in the complete inpatient sample. Similar trends were evident in the 6-10 year inpatient subgroup but these findings failed to reach significance. In terms of psychiatric outcomes (DSM-III-R) evaluated when the children were between 14 and 16 years, significant head injury status effects were found for conduct disorder and substance abuse for children in the 0-5 year olds. When analysed according to severity, increased problems were evident for the 0-10 inpatient group on measures of substance abuse, the 0-5 inpatient group on substance abuse ADHD, and CD/ODD, and mood disorders in the the 6-10 outpatient group. These findings strongly suggest that mild head injury in childhood may produce long term adverse outcomes. Therefore, it seems premature to regard all mild head injuries as a benign childhood event

Self-worth and self-knowledge in Iranian patients seeking cosmetic surgery : a comparative study

Prior research has reported a psychological impairment in patients seeking cosmetic surgery. However, the role of other variables such as contingencies of self-worth and self-knowledge has been ignored. Hence, the aim of this study was to examine new psychological structures, contingencies of self-worth, and self-knowledge among patients seeking cosmetic surgery. Eighty patients (47 female and 33 male; mean age = 28.98, SD = 8.32; 40 seeking cosmetic surgery and 40 seeking surgical treatment) were randomly recruited from the Shahid Motahhari clinic in Shiraz, Iran. The patients completed the Contingencies of Self-Worth Scale, Integrative Self-Knowledge Scale, Subjective Vitality Scale, and Depression Anxiety Stress Scale-21. The results showed that, compared to the surgical treatment group, self-worth in patients seeking cosmetic surgery was found to depend on their appearance and the approval of others. Further, the self-knowledge in patients seeking cosmetic surgery was lower than that of patients seeking surgical treatment. In addition, there were no significant differences between the two groups in vitality, depression, anxiety, and stress. It can be concluded that patients seeking cosmetic surgery have lower self-knowledge and their self-esteem depends on their appearance and the approval of others

An Investigation of the Cognitive and Psychiatric Profile for People with Parkinson's Disease Without Dementia.

Introduction: Idiopathic Parkinson's disease (PD) is a chronic and progressive neurodegenerative disorder that is characterised by motor symptoms. However, there is increasing awareness that a range of neuropsychiatric and cognitive problems also accompanys PD. The objective of this thesis was to examine the profile of neuropsychiatric and cognitive problems for patients with PD without dementia. Parkinson's disease patients who could be identified at the time of this study were invited to participate. Each patient was individually matched to a healthy control in terms of age, premorbid intelligence, and years of education. Results: Neuropsychiatric symptoms were common for this patient group, over 40% self reported symptoms consistent with depression, 40% with physical fatigue, 38% with mental fatigue, 38% with apathy and 32% with sleep problems. More than 77% of patients with PD reported symptoms associated with at least one problem and over 46% with 3 or more problems. Increased symptoms consistent with depression and anxiety and the presence of hallucinations also predicted poorer quality of life after controlling for motor symptoms. However, the of level agreement between patient report and that of a person who know them well was low: 40.9% for apathy, 28% for hallucinations, 39% for depression, 25% for sleep problems and only 7.7% agreement for the presence of anxiety. To obtain an accurate profile of cognitive impairments patients were assessed on measures of higher order language ability and a broad range of commonly used cognitive tests. Overall, PD patients were impaired on aspects of higher-order language. However, results indicated that these deficits were not a primary effect of PD, but could be explained in terms of deficits in speed of information processing associated with the disease. Compared to healthy controls, PD patients also showed deficits on measures of executive function, working memory, problem solving, and visuospatial skills. However, they were unimpaired on measures of planning, attention and memory/learning. Deficits in problem solving were only evident for tasks with a high visuospatial content and were no longer significant when visuospatial skills were controlled for. Further investigation indicated that planning in PD patients was not impaired in general and was dependent on the sensitivity of tests used. To further examine cognitive deficits, patients were divided into groups according to their cognitive performance. Three sub-groups of patients were identified that formed a continuum of cognitive impairment from none/mild to severe. Compared to controls, one subgroup showed no or minimal impairment (PD-NCI), a second group showed a more variable pattern of severe and mild impairments (PD-UCI), and a third group had evidence of severe impairment across most of the cognitive domains tested. This latter group was labelled PD-Mild Cognitive Impairment (PD-MCI). The PD-UCI and PD-MCI groups were also significantly different from their controls with respect to their ability to carry out functional activities of everyday living. The PD-MCI group had evidence of global cognitive decline, possibly reflecting a stage of pre-clinical dementia. The severity of cognitive deficits was not associated with other clinical and demographic characteristics such as motor impairments, age or disease duration. These results were confirmed when patients were retested one year later. Conclusions: Comorbid neuropsychiatric and cognitive problems are common for patients with PD prior to any overt signs of dementia. However, PD patients are heterogeneous with regard to their presentation and different subgroups of patients are identifiable based on cognitive performance. This information has both theoretical and clinical relevance

The accuracy of adult recall for early mild traumatic brain injury

Background: Childhood mild traumatic brain injury (mTBI) has been associated with negative adult outcomes. Effective interventions require identification of the injury event. There is currently little information regarding the accuracy of adult recall of childhood mTBI. Method: Prospectively collected information from a large birth cohort was used to examine adult recall accuracy at age 25 for 161 childhood mTBI events occurring before age 10. Results: At age 25 cohort members recalled 11 outpatient injuries and 16 inpatient injuries. Recall accuracy increased with age. Logistic regression analysis distinguished between respondents who reported and did not report a childhood mTBI event correctly classifying 84.5% of cases. Age at injury, injury severity and loss of consciousness (LoC) made a unique statistically significant contribution to the model. Conclusions: Most childhood mTBI events are not recalled in adulthood. Age at injury, injury severity and LoC significantly increase likelihood of recall and should be used in measures that evaluate whether injury has occurred.Implications for rehabilitation Traumatic brain injury occurs frequently and often results in ongoing deficits in attention, concentration, executive function and later mental health problems. Identification of a history of traumatic brain injury is essential to ensure that appropriate rehabilitative input is provided. Rehabilitation professionals need to be aware that mental health problems may be secondary to a prior traumatic brain injury. It is important for rehabilitation professionals elicit an accurate history of traumatic brain injury to ensure that their treatment plans are tailored to the needs of this group