Complications
Sleep disturbance (e.g., somnolence, drowsiness) forms part of the criteria for diagnosis of concussion.[5] A longitudinal study found that 65% of 346 adults with mild TBI experienced sleep difficulties (insomnia, hypersomnia, nightmares) within the first two weeks after the injury; 41% continued to have sleep difficulties one year later.[66] Sleep medications may be utilized, but only short-term while behavioral strategies are implemented, owing to high potential for causing dependency.[98][135][138]
Although rare, occurs when the brain receives a second concussive blow before it has had a chance to recover from the first blow. This can result in severe cerebral autodysregulation and brain edema, leading to permanent brain damage or even death in some cases.[4]
Traumatic encephalopathy syndrome (TES) refers to a clinical disorder associated with neuropathologically diagnosed chronic traumatic encephalopathy (CTE).[139] Diagnosis of TES as defined by consensus-based diagnostic criteria requires (1) substantial exposure to repetitive head impacts from contact sports, military service, or other causes; (2) core clinical features of cognitive impairment (in episodic memory and/or executive functioning) and/or neurobehavioral dysregulation; (3) a progressive course; and (4) that the clinical features are not fully accounted for by any other neurologic, psychiatric, or medical conditions. Among patients meeting criteria for TES, functional dependence is graded in five levels ranging from independent to severe dementia.[139] CTE has been described in former athletes with a history of mild TBI or repetitive head impact exposure, typically accompanied by behavioral change.[3] However, a cause and effect relationship between postmortem CTE changes and antemortem behavioral and cognitive manifestations has not been demonstrated, and asymptomatic players have had confirmed CTE pathology at autopsy.[3][140][141] CTE is a postmortem diagnosis based on neuropathologic evidence. Currently there are no clear in-life clinical criteria for diagnosing probable CTE.[4]
A depressed mood after mild traumatic brain injury (TBI) may reflect an underlying pathophysiologic abnormality consistent with a limbic-frontal model of depression.[31][32] Although several studies have linked mild TBI and depression, most have low methodologic quality, high risk of bias or both.[3] Mental health issues are common, multifactorial and often present independently of participation in contact or collision sport.[3]
In many cases, psychotherapy can alleviate secondary complications due to anxiety and depression.[129] Patients can often become overly anxious or depressed if symptoms do not resolve in a typical time frame. Some studies have shown that even a single counseling session can drastically reduce anxiety and depressive symptoms and improve overall mild TBI-related symptoms, whereas others report mixed results.[130][131] Cognitive behavioral techniques can be particularly helpful to patients with affective disorders, either premorbid or resultant from the mild TBI, in understanding their anxiety and depression, to decrease the stresses associated with functional consequences of their injury.[98][132]
Psychopharmaceuticals can be prescribed to control psychiatric symptoms such as depression, anxiety, and fatigue.[133]
Antidepressants such as sertraline are reported to be more effective than tricyclic antidepressants in patients with mild TBI and are also helpful in patients with anxiety.[32][134][135]
In many cases psychotherapy can alleviate secondary complications due to anxiety and depression.[129] Patients can often become overly anxious or depressed if symptoms do not resolve in a typical time frame. Some studies have shown that even a single counseling session can drastically reduce anxiety and depressive symptoms and improve overall concussion-related symptoms, whereas others report mixed results.[130][131] Cognitive behavioral techniques can be particularly helpful to patients with mood disorders, either premorbid or resultant from mild TBI, in understanding their anxiety and depression, to decrease the stresses associated with functional consequences of their injury.[132]
Psychopharmaceuticals can be prescribed to control psychiatric symptoms such as depression, anxiety, and fatigue.[133]
Antidepressants such as sertraline are reported to be more effective than tricyclic antidepressants in patients with mild TBI and are also helpful in patients with anxiety.[32][134][135]
Risk factors for PTSD after mild TBI include lower education, antecedent psychiatric disorder, and injury resulting from violence.[2] In a study of civilian survivors of traumatic injury, PTSD was identified three months post-injury in 11.8% of patients with mild TBI compared with 9.4% of patients with no history of mild TBI. This increased rate of PTSD occurred even after controlling for injury severity.[136] In the TRACK-TBI trial, the rate of probable PTSD for individuals with mild TBI at six months was 19·2%.[137] In some cases where the head trauma was sustained under emotionally charged circumstances (car accidents, combat), the injury can become more complicated to manage. In many cases it is difficult to separate the physical effects of the injury from the emotional effects of the trauma. That is to say, there are several overlapping symptoms between mild TBI/concussion and PTSD: namely, those symptoms associated with poor or altered sleep and emotional changes.
In many cases, psychotherapy can alleviate secondary complications due to anxiety and depression.[129] Patients can often become overly anxious or depressed if symptoms do not resolve in a typical time frame. Some studies have shown that even a single counseling session can drastically reduce anxiety and depressive symptoms and improve overall mild TBI-related symptoms, whereas others report mixed results.[130][131] Cognitive behavioral techniques can be particularly helpful to patients with mood disorders, either premorbid or resultant from the concussion, in understanding their anxiety and depression, to decrease the stresses associated with functional consequences of their injury.[132]
Psychopharmaceuticals can be prescribed to control psychiatric symptoms such as depression, anxiety, and fatigue.[133]
Antidepressants such as sertraline are reported to be more effective than tricyclic antidepressants in patients with mild TBI and are also helpful in patients with anxiety.[32][134][135]
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