ptsd Posttraumatic Stress Disorder In Patients With Traumatic Brain Injury And Amnesia For The Event?

[Guest allanopie]

J Neuropsychiatry Clin Neurosci. 1997 Winter;9(1):18-22.

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Posttraumatic stress disorder in patients with traumatic brain injury and amnesia for the event?

Warden DL, Labbate LA, Salazar AM, Nelson R, Sheley E, Staudenmeier J, Martin E.

Defense and Veterans Head Injury Program, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.

Frequency of DSM-III-R posttraumatic stress disorder (PTSD) was studied in 47 active-duty service members (46 male, 1 female; mean age 27 = 7) with moderate traumatic brain injury and neurogenic amnesia for the event. Patients had attained "oriented and cooperative" recovery level. When evaluated with a modified Present State Examination and other questions at various points from study entry to 24-month follow-up, no patients met full criteria for PTSD or met criterion B (reexperience); 6 (13%) met both C (avoidance) and D (arousal) criteria. Five of these 6 also had organic mood disorder, depressed type, and/or organic anxiety disorder. Posttraumatic amnesia following moderate head injury may protect against recurring memories and the development of PTSD. Some patients with neurogenic amnesia may develop a form of PTSD without the reexperiencing symptoms.

Publication Types:

· Clinical Trial

PMID: 9017524 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9017524

[Wings]

This is BUNK science from the Defense and Veterans Head Injury Program, Walter Reed Army Medical Center. 27 patients for their study. They state "No patients met full criteria for PTSD" AND "Some patients with neurogenic amnesia may develop a form of PTSD without the reexperiencing symptoms." Blatant Contradiction. They are skewing the DSM-111 diagnosis of PTSD - in order to deny compensation for the disorder! If you read related articles, other studies independent of the DoD will state the exact opposite.

See here [israel] : One hundred twenty subjects with mild traumatic brain injury who were hospitalized for observation were assessed immediately after the trauma and followed up 1 week, 3 months, and 6 months later. All participants underwent psychiatric evaluation and self-assessment of their memory of the traumatic event. RESULTS: Overall, 17 (14%) of the participants met full criteria for PTSD at 6 months. Subjects with memory of the traumatic event were significantly more likely to develop PTSD than those without memory of the traumatic event; the difference between the groups resulted primarily from the reexperiencing cluster.

http://www.ncbi.nlm.nih.gov/entrez/query.f...3799&query_hl=2

See here [Germany]: The development of symptoms of posttraumatic stress disorder (PTSD) in patients with neurogenic amnesia for the traumatic event is recorded. With a single exception, all patients were accident victims with closed head injuries. Only about three quarters of the patients completely fulfilled DSM-III-R criteria of PTSD. Nineteen patients displayed involuntary conscious memories of aspects of the traumatic event (presenting as recurrent intrusive thoughts, images or dreams) co-existent with a complete or partial lack of voluntary conscious memories of the trauma, suggesting that different memory systems and distinct brain mechanisms subserve these phenomena.

http://www.ncbi.nlm.nih.gov/entrez/query.f...3682&query_hl=2

See here [scotland]: METHOD: Fifteen hundred case records from an Accident and Emergency Unit were screened to identify 371 individuals with traumatic brain injury who were sent questionnaires by post. The 53 subsequent valid responses yielded three groups: those with no memory (n = 14), untraumatic memories (n = 13) and traumatic memories (n = 26) of the index event. RESULTS: Groups with no memories or traumatic memories of the index event reported higher levels of psychological distress than the group with untraumatic memories. Ratings of PTSD symptoms were less severe in the no memory groups compared to those with traumatic memories. CONCLUSIONS: Psychological distress was associated with having traumatic or no memories of an index event. Amnesia for the event did not protect against PTSD; however, it does appear to protect against the severity and presence of specific intrusive symptoms.

http://www.ncbi.nlm.nih.gov/entrez/query.f...6346&query_hl=2

[Guest allanopie]

WoW!

Thanks Wings.

[Wings]

There is a horrific number of TBI's (traumatic brain injuries), veterans returning from the Iraq war. The TBI is probably the signature of Iraq's combat wounded; perhaps even as high as 60%.

"Diagnosis can be difficult even when head injury is apparent or the patient is able to describe a concussive head injury to their doctors. Even mild brain injury can cause depression, reduced cognitive functioning, nausea, sleep disturbance, erratic behavior, and violent mood swings. These disabilities are exacerbated by misdiagnosis, lack of treatment, the public¹s perceptions of brain injury and mental illness. For brain injured veterans, the lack of physical signs and the diffuse nature of symptoms is often met with skepticism, considered to be psychological, or worse, malingering." http://www.tf.org/tf/featured/01-29-04traumaticinjury.html

Although PTSD may very well be the LEAST of their organic problems, the diagnosis - more often than not - applies and deserves service-connected disability compensation.

See also: New England Journal of Medicie, Volume 352:2043-2047 May 19, 2005 Number 20. Traumatic Brain Injury in the War Zone, Susan Okie, M.D. http://content.nejm.org/cgi/content/full/352/20/2043

[timetowinarace]

"Diagnosis can be difficult even when head injury is apparent or the patient is able to describe a concussive head injury to their doctors. Even mild brain injury can cause depression, reduced cognitive functioning, nausea, sleep disturbance, erratic behavior, and violent mood swings. These disabilities are exacerbated by misdiagnosis, lack of treatment, the public¹s perceptions of brain injury and mental illness. For brain injured veterans, the lack of physical signs and the diffuse nature of symptoms is often met with skepticism, considered to be psychological, or worse, malingering." http://www.tf.org/tf/featured/01-29-04traumaticinjury.html

I am one of these from the first gulf war. I was hospitalized for several weeks for a closed head injury in '91. I returned to duty and fought in the ground assault. For 14 yrs I've been complaining of problems and even a draining feeling in my ear. I was put on anti-depressants. I told everyone I had a head injury. I was put on anti-depressants. Last Jan. at a C&P for depression secondary to SC undiagnosed fatigue (a symtom of brain injury) the examing Psych said it was my brain damage causing it all. It turns out that the draining feeling in my right ear is ceribral spinal fluid leaking from my brain. I had filed a claim in '97 for right ear disorder that was denied because there was nothing wrong with it. Oh, I better quit here. I could go on for a while. Better to just swallow a little more of my brain fluid and relax. Oh, the way they VA distiguishes between Mild Brain Trauma and PTSD for diagnostic purposes is simply avoidance of the event/stressor. Otherwize symptoms are the same.

Time

[Wings]

I am one of these from the first gulf war. I was hospitalized for several weeks for a closed head injury in '91. I returned to duty and fought in the ground assault. For 14 yrs I've been complaining of problems and even a draining feeling in my ear. I was put on anti-depressants. I told everyone I had a head injury. I was put on anti-depressants. Last Jan. at a C&P for depression secondary to SC undiagnosed fatigue (a symtom of brain injury) the examing Psych said it was my brain damage causing it all. It turns out that the draining feeling in my right ear is ceribral spinal fluid leaking from my brain. I had filed a claim in '97 for right ear disorder that was denied because there was nothing wrong with it. Oh, I better quit here. I could go on for a while. Better to just swallow a little more of my brain fluid and relax. Oh, the way they VA distiguishes between Mild Brain Trauma and PTSD for diagnostic purposes is simply avoidance of the event/stressor. Otherwize symptoms are the same.

Time

Time, I am sorry for your combat injury and feel outraged with the VA's inadaquate medical attention! I hope you have since filed a proper claim for the closed head injury? Yes? Your recent C&P Examiner's report seems helpful!! Hope that you get the help you need and desrve.

[Jay Johnson]

I posted a topic in the "medication" section awhile back on a similar topic - Propanolol ....It has been shown that disrupting the memory BEFORE PTSD sets in can reduce PTSD symptoms. This doesn't mean there's a cure, nor does it mean that it is guaranteed to work, but having the VA focus on helping future vets to have lesser symptomology is better then having them focus on "curing" PTSD after the fact (IE - lowering existing ratings).

Honestly, I think the VA should embrace the study I linked because it refutes the fact that amnesia can stop PTSD AND can help future vets by decreasing symptoms on the battle field before it becomes a life-long problem.

Edited December 7, 2005 by Jay Johnson