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

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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

[timetowinarace]

Jay,

The Defence and Veterans Brain Injury Program are allowed to readminister the ASVAB to patients within 6 months of service. No one else is allowed to retake it. They are trying to protect the integrity of the test. The ASVAB is is almost the only commonly taken test not accepted by MENSA. The reason? The Gov. has speciffically asked them not to. Though it is claimed that the ASVAB is not an IQ test, it has the uncanny abillity to detect the g facter. General Intelligence.

Reaseach article, Dept. of Psych.

From the NLSY79 data set, we extracted measures of performance on the Armed

Services Vocational Aptitude Battery (ASVAB) and the SAT (known as the Scholastic Aptitude Test at that time), as well as a number of intelligence tests that did not have scores available for as many subjects ("small-N" tests).A principal-axis factor analysis was performed on the 10 subtests of the ASVAB in order to derive a measure of g. This analysis included 11,878 of the 11,914 subjects who had taken the ASVAB. The remaining 36 subjects were excluded because they were missing scores for 1 or

more subtests. ASVAB scores were chosen in place of scores on some of the more traditional intelligence tests because ASVAB scores were available for nearly all of the NLSY79participants (11,878 of 12,686). Furthermore, prior analysis of the ASVAB confirmed a hierarchical g model in which 64% of the variance in the ASVAB was due to a general factor (Ree & Carretta, 1994; see Roberts et al., 2000, for an alternative model). Results of the factor analysis of the ASVAB are shown in Table 1. They indicate a substantial loading of all subtests of the ASVAB on a first factor, g. ASVAB first-factor scores were transformed to an IQ scale using the following equation:IQ = (z * 15) + 100.Finally, the IQ scores derived from the ASVAB were correlated with SAT scores for the 917 respondents who had scores on both measures. Simple correlations between both SAT scores and ASVAB IQ scores and scores on the small-N intelligence tests were also analyzed.

Can post the whole thing if interested. Regardless it can't be used.

Wings,

Title 38 Chapter I Part 4 Subpart B Sec 4.124a

Purely subjective complaints such as headache, dizziness,

insomnia, etc., recognized as symptomatic of brain trauma,

will be rated 10 percent and no more under diagnostic code

9304. This 10 percent rating will not be combined with any

other rating for a disability due to brain trauma. Ratings in

excess of 10 percent for brain disease due to trauma under

diagnostic code 9304 are not assignable in the absence of a

diagnosis of multi-infarct dementia associated with brain

trauma.

I have done extensive research on brain trauma. The only place I have seen the words "multi-infarct dementia associated with brain trauma" are in this reg. Multi-infarct dementia is diagnoses given to the elderly. However, I have found definition of multi-infarct dementia as being multiple random cognitive impairments with no mention of stroke. Let me explain. My testing shows I have above average language skills in the 70% range. But I have verbal skills in the 3% range. A contradiction. My overall memory functions are fully intact. My working memory is allmost nonexistant. A contradiction. And my memory in general is poor despite the functions being there. A contradiction. This is how the neuropsychologist determines if my deficits are due to brain trauma. Not just one area is affected, and some are not effected at all. This is allso why they use this testing to rule out malingering. You can't fake multiple areas of deficts consistantly on multiple tests because they use different methods to find them. So you see, if you leave the infarct part out, (the word is there to imply organic damage) I fit. Not every person with brain trauma is going to show tiny strokes throughout their brain. Not even if severely injured. They do not show on imaging for the elderly in most cases. Neuropsych testing is now the most relied on method of detecting brain damage due to trauma. This has to be the definition meant, otherwise very few seriously injured could quallify for comp.

brain injury recourse center

BIA

services for veterans

Edited December 9, 2005 by timetowinarace

[Wings]

Brother Vet, Your psychologist has stated your cognative impairments are secondary to in-service head trauma to the brain. Your neuropsychological testing shows organic impairment. This is GREAT evidence to have in support of your claim. Leave off the words "multi-infarct", re-read Sec 4.124a and then combine 4.126 (et all) -- see here:

§ 4.126 Evaluation of disability from mental disorders.

(a) When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination.

(b) When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment.

© Delirium, dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for delirium, dementia, or amnestic or other cognitive disorder (see §4.25).

(d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see §4.14).

(Authority: 38 U.S.C. 1155)

*You seem to fall into numerous schedules for rating disabilities. You have been diagnosed with depression too!

Hey, I'm only suggesting your evidence be evauluated by a Psychiatrist of your own choosing 'cause the VA is going to hand it over to an M.D. eventually. I wouldn't worry about the specific terminology just now, not unless you get a very clear neuro diagnosis from a specialist. You are facing organic brain damage with cognative impairment and seconday mental disorders. I think you should pay to see a psychiatrist who can put it all together for you. What do you think? I did work in a Neuropsyche testing lab at Wilford Hall medical center for 3 years: head wounds, gunshot wounds to the head, strokes, etc. It sounds like you are suffering short term memory problems as well as some aphasia ... yes? Hang in there, stay confident, I think you are hot on the trail! ~Wings

[Jay Johnson]

Time,

What you are referring to is the AFQT portion (subset) of the ASVAB; furthermore, the idea of "g" is a concept from a widely discredited book by Herrnstein and Murray entitled "the bell curve". They used the AFQT to come to conclusions about differences in IQ between different races and economic backgrounds, but the overwhelming majority of the field of psychiatry believes that "the bell curve" simply measured gaps in achievement and not IQ. Basically, the ASVAB, and it's subsection AFQT, is nothing more then a measurement of achievement and has no clinical basis in intelligence.

What "the bell curve" did wrong is it used standardized tests as a means evaluating "general intelligence" (g). Standard tests do NOT measure IQ in any way. In fact, one of the most brilliant mathematicians in our history could barely read or write...he was a peasant from india that a college professor "discovered" as having a profound ability at math. This indian ended up scoring higher on an IQ test then einstein, but would have scored a zero on a standardized test (ASVAB, SAT, etc). The writers of the bell curve went on to say that blacks were, essentially, a less intelligent race based on lower scores on standardized tests, but they failed to take into account socio-economic background. You see, a poor black kid from the south scores, on average, 20 points lower on "the bell curve" then do middle class black kids from the north. The same can be said for asian kids...asian kids score, on average, 5 points higher then whites (as per the "g" quotient listed by herrnstein and murray), but a closer look shows that "the bell curve" only tested american asians that came from rather well-off backgrounds...when you apply the "g" quotient to asians in china, korea, japan, etc from lower economic backgrounds they score as low as the poor black kids do.

In my opinion, the "g" factor is racist nonsense used to promote a white agenda and white power.

P.S. - I did a paper on the "bell curve" in my college sociology class:-) (hence the emotion)

P.P.S. - I found an article about the ASVAB and IQ with an excerpt from a DoD official on the topic -

>>>Richard Danzig, Principal Deputy Assistant Secretary of Defense for

Manpower, Reserve Affairs, and Logistics spoke before a congressional

committee. "The testing specialists note that we ought not to confuse

these aptitude tests with intelligence tests as such" Danzig said.

"Naturally there is some correlation between the two types of tests but to

speak of somebody as being in category IV or category V is not per se to

make a judgment about his intelligence. ... In fact, we don't want to test

IQ which is traditionally the aptitude of school children to perform well

in school. We want to test their ability to learn to perform military

jobs. That is somewhat related to intelligence, not alone intelligence

however. I want to avoid that implication" (Congressional Record, U. S.

Senate, 1980, p. 1298)<<<

[timetowinarace]

Sorry if I come off as confrontational. It's just frustration. I still don't know if I'm coming or going most of the time and the VA has refused treatment. I don't trust them with my claim either, of course.

My neuropsych report is quite long with all the seperate results and comparisons and explaination, interpretations and what not and I only put a couple examples in that last post. But, here is the end of it.

Based on these findings, I recommended the following to Mr. Price:

1. That he discuss with his physicain possible medication to aid with his symptoms of depression and attentional difficulties. An antidepressant and possibly a psychostymulant would seem appropriate considerations.

2. In addition, I recommended to Mr. Price that he concider psychotheapy to aid in managing his symptoms of depression and anxiaty, as well as his adjustment to cognative and physical changes related to his brain injury. He is schedualed to begin treatment with Marty Cooke, a licenced councilor in our office, to this end.

3. Once Mr. Price's functioning is stabalized with medication, I recomended that he consider a trail of college course work. His chance of success would be significantly enhanced with appropriate accommodations, including the following:

A. That he be provided additional time in a quiet envirnment for test taking.

B. That he be provided with notes and additional tutoring support as needed for more difficult courses.

Again, thank you for refering Mr. Price for Neuropsychological evaluation. Please let me know if I can provide any additional assistance.

Sincerely,

Theresa Ross, Ph.D.

Clinical Psychologist

I'm on wellbutrin and ritalin. The stimulant is because most of my memory and attention problems are because my proccessing speed is so slow. It is not that I 'forget' where I put my keys. It's more that I never KNEW where I put them to begin with. I can't do two things at the same time. (walk and chew gum. LOL) So when I put my keys down while talking to the wife, my brain never proccesses the location of the keys because it can't. So they are lost. I can type this because I have plenty of time to do so. If I were to have this conversation face to face you would only get a small % of the information I have in my head and I would remember very little of what you told me.

College coursework was recommended because when she asked what I wanted to do, I explained that my physical health did not allow me to work a physical job. So I wanted to return to Voc Rehab. At first she told me that was not an option, that I could not function in an academic envirnment. Then thought that if the ritalin helped substatially I may be able to take one to two classes a semester.

Anyway, there ya go. My recourses are limited in this area. I've been concentrating on getting my CSF leak found and fixed.

Time

[Jay Johnson]

Sounds like a short term memory problem in my opinion...I have a civilian friend who is on SS due to short term memory issues as a result of a diabetic coma.

[Wings]

Sorry if I come off as confrontational. It's just frustration. I still don't know if I'm coming or going most of the time and the VA has refused treatment. I don't trust them with my claim either, of course.

My neuropsych report is quite long with all the seperate results and comparisons and explaination, interpretations and what not and I only put a couple examples in that last post. But, here is the end of it.

Based on these findings, I recommended the following to Mr. Price:

1. That he discuss with his physicain possible medication to aid with his symptoms of depression and attentional difficulties. An antidepressant and possibly a psychostymulant would seem appropriate considerations.

2. In addition, I recommended to Mr. Price that he concider psychotheapy to aid in managing his symptoms of depression and anxiaty, as well as his adjustment to cognative and physical changes related to his brain injury. He is schedualed to begin treatment with Marty Cooke, a licenced councilor in our office, to this end.

3. Once Mr. Price's functioning is stabalized with medication, I recomended that he consider a trail of college course work. His chance of success would be significantly enhanced with appropriate accommodations, including the following:

A. That he be provided additional time in a quiet envirnment for test taking.

B. That he be provided with notes and additional tutoring support as needed for more difficult courses.

Again, thank you for refering Mr. Price for Neuropsychological evaluation. Please let me know if I can provide any additional assistance.

Sincerely,

Theresa Ross, Ph.D.

Clinical Psychologist

I'm on wellbutrin and ritalin. The stimulant is because most of my memory and attention problems are because my proccessing speed is so slow. It is not that I 'forget' where I put my keys. It's more that I never KNEW where I put them to begin with. I can't do two things at the same time. (walk and chew gum. LOL) So when I put my keys down while talking to the wife, my brain never proccesses the location of the keys because it can't. So they are lost. I can type this because I have plenty of time to do so. If I were to have this conversation face to face you would only get a small % of the information I have in my head and I would remember very little of what you told me.

College coursework was recommended because when she asked what I wanted to do, I explained that my physical health did not allow me to work a physical job. So I wanted to return to Voc Rehab. At first she told me that was not an option, that I could not function in an academic envirnment. Then thought that if the ritalin helped substatially I may be able to take one to two classes a semester.

Anyway, there ya go. My recourses are limited in this area. I've been concentrating on getting my CSF leak found and fixed.

Time

Dear Veteran, Have you applied for your VA War Pension at the same time as you applied for VA Compensation? Seems to me you meet the current standards if your not working. You are working hard on your claim. Hang in there and keep us posted! ~Wings