Research Reports - The evolution of posttraumatic stress disorder following traumatic brain injury

J Neurotrauma. 2015 Jul 15

Alway YJ(1), Gould K(2), McKay A(3), Johnston L(4), Ponsford J(5)

Increasing evidence indicates that posttraumatic stress disorder (PTSD) may
develop following traumatic brain injury (TBI), despite most patients having no
conscious memory of their accident. This prospective study examined the
frequency, timing of onset, symptom profile, and trajectory of PTSD and its
psychiatric comorbidities during the first four years following moderate to
severe TBI. Participants were 85 individuals (78.8% male) with moderate or severe
TBI recruited following admission to acute rehabilitation between 2005 and 2010.
Using the Structured Clinical Interview for DSM-IV Disorders (SCID-I),
participants were evaluated for pre- and postinjury PTSD soon after injury and
reassessed at 6 and 12 months, 2, 3, and 4 years postinjury. Over the first four
years postinjury 17.6% developed injury-related PTSD, none of whom had PTSD prior
to injury. PTSD onset peaked between 6- and 12-months postinjury. The majority of
PTSD cases (66.7%) had a delayed-onset, which for a third was preceded by
subsyndromal symptoms in the first six months postinjury. PTSD frequency
increased over the first year postinjury, remained stable during the second year
and gradually declined thereafter. The majority with PTSD experienced a chronic
symptom course and all developed one or more comorbid psychiatric disorder, with
mood, other anxiety and substance-use disorders being the most common. Despite
event-related amnesia, posttraumatic stress symptoms, including vivid
re-experiencing phenomena, may develop following moderate to severe TBI. Onset is
typically delayed and symptoms may persist for several years postinjury.

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