Assessment of Psychiatric Issues in Post-concussion Syndrome

The term "Post-Concussion Syndrome" (PCS) refers to a group of non-specific symptoms that occur after a concussion or Mild Traumatic Brain Injury (MTBI) and last longer than expected. Headaches, weariness, vertigo/dizziness, irritability, emotional lability or irritability, cognitive problems, sleep disturbance, anxiety, and depression are all possible symptoms. According to Silverberg and Iverson, both neurobiological and psychosocial factors influence symptoms during the early phases of recovery [1].

Prior history of head injury, neurological symptoms, female gender, older age, and psychological difficulties before and after the accident have been linked to persistent PCS development [1]. Following factor analysis, two distinct symptoms emerged: post-concussive-cognitive symptoms, which included typical PCS symptoms, and the second set of issues, which included decreased work capacity/efficiency, fatigue, and emotional-vegetative symptoms like heart palpitations, gastrointestinal problems, depression, and emotional lability. Gouvier and colleagues [2] investigated the notion of PCS as a decline in the ability to compensate for stressful situations as a result of residual harm. Rutherford and colleagues observed that 51% of people with mild head injuries reported PCS six months after the accident, and 14.5% had symptoms a year later [3]. Females, the elderly, and those with positive neurological indications 24 hours after damage were more likely to experience symptoms [3]. Fenton, et al. [4] discovered that PCS was substantially connected to older age and female gender and that moderate head injury patients with persistent PCS had a higher prevalence of pre-morbid social issues as well as anxiety or depression disorders six weeks after the injury. Bohnen, et al. [5] conducted a large study to look into the severity of everyday and post-concussion symptom complaints such as dysthymic complaints (depression, anxiety, tearfulness, and so on), vegetative/ bodily complaints (headache, vertigo, light-headedness), and performance complaints (decreased work performance, forgetfulness, etc.). In a cohort of college students with a self-reported history of MTBI, Ryan and colleagues [6] discovered that a combination of psychosocial, premorbid, and neurocognitive variables predicted persistent PCS. Level of current post-injury psychological discomfort and female gender were the most predictive variables. At six weeks after injury, Snell [7] found high impact sizes for anxiety and depression in patients with PCS than those without.

PCS is a collection of physical, cognitive, and behavioral symptoms that most commonly arise after an MTBI but can also occur after more serious injuries. PCS usually goes away after a month, but it might last for months or even years in some people. Several pre-morbid, injury-related, and post-morbid neuropathological and psychological variables are believed to contribute to the development and persistence of these symptoms, according to the body of research to date. If the post-concussion syndrome is diagnosed, it should not be presumed that the difficulties are mostly due to traumatically induced cellular damage without further investigation. The post-concussion syndrome should be treated as an excluding the diagnosis. The clinician should carefully examine the symptoms and their evolution through time and rule out the most evident differential diagnoses or competing explanations for the symptoms. Treatment (both psychological and pharmacological) that tackles the breadth and depth of elements that may be creating and perpetuating a person's symptom reporting and issues in everyday life can be implemented.

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6. Ryan LM, Gouvier WD, Schrager D. Predictors of post concussion symptoms in mild head injury. Archives of Clinical Neuropsychology. 1988;13:147.
7. Snell DL. Mild traumatic brain injury: A prospective repeated measures study investigating the influence of illness perceptions and coping on clinical outcome. Doctoral dissertation, University of Otago, New Zealand, 2010.