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

[Guest Jim S.]

"the lack of physical signs and the diffuse nature of symptoms is often met with skepticism, considered to be psychological, or worse, malingering."

This is on point with my argument that the C&P exmination was inadiquate for adjudication purposes, that the examiner could not visualize that which took the Naval Dr's and Psycholigist special testing to detemine and having not done any of the same or similiar testing to refute the Naval Dr's and Psychologists findings, does not rise to the level of evidence to rebut the benefit of the doubt and rebut the presumption of sound condition. further that it is shown that the C&P examiner failed to concider the possible psychological effects the trauma to the brain may have had, when a personality disorder was noted six months after the event occured.

Again it brings to my mind as to why the VA can SC a Nasal Fracture, but not the accompaning Concusion, even if mild, given the difficulties in visulizing the psychological and diffuse nature of the symptoms and the fact that these may well take days, months or even years for them to develop to a degree that they may well be visualized and/or it's psychological effects could be determined as being caused by the traumatic head injury.

This furthers my idea that the VARO is not doing their job in a non adversarial manner and is doing all they can to see that Veterans receive the benefits that are rightfully theirs for their SC disabilities. The VARO should be looking at the C&P exam in the same manner as they do the information supplied by the Veteran, not using it as a tool to deny the benefits due the Veteran.

Jim S. :)

[Jay Johnson]

I think the studies help prove my theory that PTSD IS a brain injury and not merely a psychological one. If a physical brain injury can produce very similar symptoms to PTSD then why can't they draw the lines between the two? In my opinion, one's brain damages itself in order to better cope with a traumatic event, but that "rewrite" of the brain has negative side effects which are expressed via PTSD symptoms. I don't think the VA wants to make that connection because it will mean that most PTSD cases would be permanent in nature and the psychiatric community won't admit it because they would be out of a job as far as the value of therapy is concerned......I think trying to talk someone into recovering from PTSD is like trying to talk someone into recovering a lost arm (it's not gonna happen).

[wallyg]

This is BUNK science from the Defense and Veterans Head Injury Program, Walter Reed Army Medical Center. 27 patients for their study.

Wings,

There were 47 patients in the study - there average age was 27.

There is nothing in the study to justify your categorization of "Bunk".

The other studies you cited ontradict each other, and the German one doesn't state the number of subjects evaluated.

In fact, the Scottish study, with the most subjects, would tend to support what the Walter Reed study reported. I don't think you were dispassionate when reading and analyzing this report. I can sympathize with your feelings, but not with your conclusion.

[Wings]

Wings,

There were 47 patients in the study - there average age was 27.

There is nothing in the study to justify your categorization of "Bunk".

The other studies you cited ontradict each other, and the German one doesn't state the number of subjects evaluated.

In fact, the Scottish study, with the most subjects, would tend to support what the Walter Reed study reported. I don't think you were dispassionate when reading and analyzing this report. I can sympathize with your feelings, but not with your conclusion.

Walter, Thank you for correcting the numerical quotient: 27 vs 47 is an distinct variable. However, I still say BUNK. They could have done better research. They could have skewed the data to show the percentage of patients that DID meet the criterian for PTSD (in their own words, "a form of PTSD"). Instead, their study suggests that NOT ONE patient met the FULL criteria. I posted the other studies to show that TBI patients OFTEN meet the FULL criteria for a PTSD diagnosis.

[timetowinarace]

I posted this somewhere before. I think it was for Jim. Don't know if he saw it.

Differential Diagnosis

In those individuals reporting long-term PCS symptoms following MTBI,

their clinical presentation may be very similar to related disorders, including

post-traumatic stress disorder, major depression, disability seeking behavior,

or malingering. For instance, individuals may report sleep difficulties,

memory problems, irritability, and anxiety that fit any of these diagnoses.

Mittenberg and Strauman (2000) suggest the following considerations in

differential diagnosis:

• Post-concussion Syndrome versus Post-Traumatic

Stress Disorder. PCS is not associated with persistent reexperiencing

of the accident or numbing of general

responsiveness, whereas PTSD is. In contrast, PTSD is not

characterized by headaches, dizziness, generalized memory

problems, or subjective intellectual impairment, while PCS is.

• Post-concussion Syndrome versus Major Depression. PCS is

not associated with changes in appetite or weight, psychomotor

agitation or retardation, suicidal ideation, or a history of

depressive disorder.

• Post-concussion Syndrome versus Disability Seeking or Overt

Malingering. While a malingerer may convincingly report many

symptoms of PCS, level and pattern of performance on formal

neuropsychological testing can be used to differentiate between

the two presentations, at least in cases where the medical record

clearly indicates that the head injury was mild. However, it is

certainly possible that individuals with legitimate post-injury

symptoms may also amplify or exaggerate their problems. These

cases are the most difficult to tease apart contributing etiologies,

although a careful history, collateral interviews, and formal

neuropsychological assessment are often useful.

Veterans health initiative-links to training manuals

Wings,

Combat injury, no. A sledge hammer fell through the gun hatch and landed on my head. I had filed a claim in '03 and was denied for lack of records. Could not find records nor had diagnoses, just knew I was messed up. It went no where. Appeal in for depression and reopened head injury claim after hunting down records. Have testing and diagnoses. Just waiting.

Time

[Wings]

Time, Differential Diagnosis information was useful; most notably is the use of neuropsychological testing for cognative impairments. Did the VA give you a battery of tests or did you need to get those independently? Combat or no combat, service related injury nonetheless. How much does a sledgehammer weigh anyhow?! Ouch!! BTW, how did you go about "hunting down" your SMR''s (service medical records)? This is a tricky subject, one that comes up time and again with many vets - and your success might prove helpful to others . . . Hang in there!! ~Wings

Edited December 8, 2005 by Wings