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Post by Admin on Dec 7, 2015 17:40:09 GMT -4
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Post by Christine Sipple on Dec 8, 2015 14:41:17 GMT -4
This article is a fantastic reminder for all of us to consider the aftereffects of head injuries in not only our patients, but in our friends, families, and even in ourselves. I have seen my share of significant bumps on the head in my years of skiing, snowboarding, skating, and mountain biking, but it wasn't until a serious head injury after a fall in 2008 that I can recall feeling some of the symptoms described in this and in other articles. I had significant depression, personality changes, anxiety, anhedonia, flat affect, all of it, but it was years before I put all of the pieces together and understood that the head injury was the cause. It took months after the fall for me to laugh again, and years before I felt "normal" again. The people around me didn't understand what I was going through at the time, not even my neurologist or ER doctor friend. No one mentioned this might happen following a concussion.
The mental health aspect of these injuries can slip by us so easily if we don't remember to think about more than the physical bumps, bruises, scrapes and cuts.
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Post by reshikamendis on Dec 9, 2015 16:22:45 GMT -4
This is not the only article that is published which shows a correlation between concussions and depression. Another article quoted that "a head injury can lead immune-system brain cells to go on “high alert” and overreact to later immune challenges by becoming excessively inflammatory – a condition linked with depressive complications". This could possibly mean that some depressive symptoms are inflammation related and some common antidepressants might not work on these patients. Would dTMS work for these particular patients? Is a past history of concussions now necessary to be taken now to see what kind of depression the patient has or where the depression is arising from? I think there definitely needs to be more research done on the topic before anything concrete can be determined but it is definitely interesting where it is already leading.
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Post by Rachel Riley on Dec 9, 2015 17:30:13 GMT -4
As physicians, our main job is to inform our patients what to expect and look out for to ease the frustrations of their healing time. I feel that this is something that some physicians have lost touch with and they should pay more attention to. My brother had a open head injury and was not informed that he might experience anxiety and depression throughout his course of healing. This became very frustrating to him and the family, as it affected everyone around him. Once we received knowledge that this is something that might occur due to the brains healing process, then we could justify his mood swings and lack of motivation to do anything. But before we were informed, this was extremely frustrating and we put more pressure on my brother than we should have. No matter what physician any of us become, this is something that we should always keep in mind to educate our patients with.
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Post by Amy Jones on Dec 9, 2015 17:47:03 GMT -4
We have known for a long time now that professional football players experience more problems later in life. The suspicion is that it is related to the multiple TBIs. We can assume then that teens or children would experience problems earlier and perhaps more intensely as their brain matures. The take home message is taking a good medical hx is important. It could seem counter intuitive that a psychiatrist would be interested in musculoskeletal injuries but they could be an indication to a deeper issue. It is important to understand the link between the mind and body as a whole unit. Futhermore, physicians need to work closely with each other. Given that recent studies indicate,
- [in] The first six months, 36 percent — 25 of 70 children — experienced a new onset of psychiatric
disorders. Ten percent experienced full depressive disorder. When Max followed up at the 12-month
mark, the overall number had fallen, but 28 percent of the children were still experiencing a psychiatric
disorder.
He says more serious brain trauma only exacerbates matters. After a severe head injury, the rate of onset
of new psychiatric disorders in children is 50 to 60 percent. For comparison, the rate a year following
an orthopedic injury — a leg fracture or knee sprain, for example — is 10 percent. “Astounding,” Max puts it.
These children need to be referred to a psychiatrist upon their discharge from the hospital. They need to have a plan of action in place for what could happen. The phsycians, parents and children need to have a plan of care that is ready in the instance that the child becomes suicidal.
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Ann Mary Kalapurakal
Guest
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Post by Ann Mary Kalapurakal on Dec 9, 2015 18:26:22 GMT -4
In the medical field it is our tendency to focus on scientific reasoning for diseases and disorders. We conduct imaging studies, determine neurotransmitter levels or gather other test results to reach a conclusive diagnosis. What we fail to consider is how the patient feels after a traumatic experience, such as a concussion. Their signs and symptoms of depression may be a normal reaction of grief to recent life changing events. We fail to understand how it holds them back from their dreams, hopes and aspirations. There is one common factor that people who suffer brain trauma experience, and that is the feeling of inadequacy. They are unable to participate in extracurricular activities they had immense passion for, which enabled them to show case their talent. These activities also allowed them to feel rewarded for reaching their maximum potential. For some people these activities are a form of escape from normal stressors of life, and to have it suddenly taken away after a traumatic injury can leave the people feeling unfulfilled. There is a void that needs to be filled, and this void can lead to anxiety, self-doubt and depression. The article even stated that Kaelin “was harassed and teased for not returning to the team quickly enough”. The pressure of having to stay on top and have life figured out at an early age is unfortunately the downfall for many young people in this competitive era. This “competition” can lead people with brain injuries to feel even more hopeless, helpless and alone. Sadly, taking their lives may have been their cry for help. The article has opened my eyes; we should not only prioritize the pharmacologic/surgical treatment but also provide psychological therapy to help the patient feel more confident, stay positive and to support them to get back on track with their life again.
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Post by Caroline Estiverne on Dec 9, 2015 19:14:17 GMT -4
It is a problem that is frequent in this age group and affect so many young people in this country. We are the future generation of practitioners and this is a challenge due to the varieties of symptoms. Those young people along with their family need to have better support from the medical society. We have to start thinking about their feelings before they get turned away with no hope. Having a teenager who is having issues with mental illness because of a concussion can be very frustrating and heart breaking. We have to be more human and talk to the family as much as possible so they know that they are not alone in the fight. Teaching and listening can be sometimes all people want from a medical doctor. Show them that they matter. This a serious problem and it is not going away anytime soon because more young people are into sports these days. We have to keep an open mind and be our brothers' keeper so we could be able to do what we can or if not, refer them to someone who will be of help to them.
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Post by Kristy Amores on Dec 9, 2015 19:45:20 GMT -4
This is an interesting and cautionary article. I know after reading this, I’m more aware. It brought up a memory about a cousin of mine that experienced a head injury. She lived with my family for a while, so I knew her pretty well. She experienced a serious head injury due to a fall and had to get surgery. I was young, I don’t remember the details of the surgery or anything. What I do remember is her change in personality. Even after recovering from the surgery, she never went back to the way she was. Before, she was very outgoing, energetic, and loved to be around people. After, she became very much the opposite. This article just reminds me that treating the mind is just as important as treating the body.
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R.L.
New Member
Posts: 1
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Post by R.L. on Dec 9, 2015 22:48:19 GMT -4
This article is important because it shows links between the number of concussions and the more likely it is for the injured to develop depressive symptoms. As medical professionals, we should include head trauma in our differential for a cause of depression, especially in young athletes. If not properly diagnosed and treated, depression can lead to suicide. The article found that suicide occurred in professional football players that developed chronic traumatic encephalopathy (CTE), and the “causal relationship between CTE and concussion is unknown,” but we need to be aware that this patient group is at risk. We can begin proactively screening and monitoring patients with a history of concussion for signs of depression and treat the depression earlier in its course.
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Post by msingson on Dec 9, 2015 22:54:49 GMT -4
While it is reassuring that these short term changes (e.g. memory loss, headaches, dizziness, confusion, etc.) seem to resolve, it is concerning that certain symptoms such as changes in neurologic functioning in terms of memory and mood impairment may persist for longer periods of time. For these patients, and especially those who have had multiple concussions, it is good that they are now also being closely monitored and screened for symptoms of depression and other mental illnesses to prevent mental and social issues such as those mentioned in the case of Kosta.
As for the rehab therapy that was mentioned towards the end of the article, I found it interesting that there is that option for a treatment modality. I’ve always assumed for those individuals who have had head trauma were only treated with pharmaceutical therapy and rehab therapy that focused on whatever affected limb(s). It’s a shame the author only mentioned it in passing and didn’t go further into its mechanics.
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Post by Robert Seminara on Dec 9, 2015 22:58:23 GMT -4
Looking back at high school, I participated in wrestling and basketball; both with intentions of ‘going pro’ one day. I don’t even know what ‘going pro’ in wrestling was other than the Olympics or WWE (UFC did not exist at the time). I had a few injuries, but some had it worse, and reading this article revealed how crucial and sensitive recovery from even one concussion can be. I do not remember anyone who ‘may’ have had a concussion sitting out for the ENTIRE SEASON like Kamzelski did. It would almost be unheard of at the time. There is an enormous amount of pressure and respect given to someone who can ‘shake it off’ for lack of a better phrase. It seems only recently, that the link between depression and concussions is getting the attention it deserves and I think every athlete and perhaps their family needs to be aware of the risks involved.
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Post by Dhaval Ray on Dec 9, 2015 23:29:29 GMT -4
This is an excellent article to read if one is not aware of the impact a concussion has on a person. It is very important to take appropriate measures in identifying and treating the symptoms early during the process. Not only parents, but also the coaches and the athletes should also take appropriate care to prevent concussions. I am surprised to learn about the symptoms of concussions as they range from simple headaches to depression to suicidal ideations and in some even cases suicide. As doctors, our job is to identify any triggers for specific symptoms the patient is experiencing and further inquire about the cause, since, to the high school football player, playing football might not even cross his mind as a cause of depression or suicidal thoughts. I think that we should educate athletes, no matter the age, about what a concussion is and what the consequences of a concussion are and that they should report any form of trauma to their coaches or parents so they can get them seen by a physician.
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Post by Esaias Jordaan on Dec 10, 2015 0:00:29 GMT -4
I find this to be a very interesting topic in terms of epidemiological analysis. It will be interesting to see if concussions sustained from different angles under similar circumstances display similar symptoms, or if global signs predominate. The article unfortunately does not delve into the prevalence of other neurological signs caused by traumatic brain injury (e.g. do we commonly see horizontal nystagmus from 6'th cranial nerve palsy, psychotic features, or changes in CSF flow?). If depressive symptoms predominate post-TBI, is it possible that psychogenic factors are at play, or is it mainly that so many neural pathways are implicated in the etiology of depression and/or that they are particularly prone to injury? In any case, this is a field that requires serious scientific inquiry alongside an aggressive public outreach effort to reduce stigmatization and increase presentation.
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Post by Shane Lukose on Dec 10, 2015 0:12:45 GMT -4
Many of us would not automatically link a "knock to the head" to lifelong mental illness. However increasing evidence is strongly suggestive that trauma to the brain can result in bouts of depression and anxiety in young athletes. Looking at the cases of individuals like Kaelin and Kosta it's hard to deny the connections made. These young adults were content, sound minded people who after their accidents took a turn for the worse, having suicidal thoughts and even taking their own lives. Sara Chrisman suggests that the symptoms of depression very much overlap with those of concussion, furthermore the target group are college aged, of whom are generally known to be more vulnerable to conditions such as schizophrenia, depression and anxiety. The lines are very blurry when it comes to this topic. However this is certainly not a subject that should be left alone. Further research in to this is vital, with enough new evidence suggesting strong linkage between concussions and depression, It could hold great benefits to many, for example, current and former NFL players with a history of concussions, victims of car crashes, military veterans etc. Monitoring them for signs of depression enables early diagnosis. Depression is manageable however left untreated could lead to the loss of many lives, which is why if there are associations with trauma and mental illness, it is imperative to detect these as soon as possible.
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Post by Adham Saleh on Dec 10, 2015 9:15:50 GMT -4
For years this topic has been ignored, dating all the way to the year of 1933, where all sport programs across the nation where warned about the effects of concussions on their players and were handed specific guidelines to follow if a player were to suffer from a TBI. However, many programs rejected the idea of the complying with the guidelines. Moreover in the year of 1952 a study published in the NEJM urged football players to leave football forever if they have suffered three concussions. Once again the notion of accepting the facts was completely ignored. In 1973, the neurological condition, the “The second impact syndrome” was introduced, yet the major sport industries failed to act; this syndrome occurs when an athlete or person suffers another concussion while still dealing with the symptoms of the first one, with reference to a study conducted in the year of 2013 also in the NEJM, people who suffer the second impact syndrome have a 90% mortality rate. For the first time in 1994, the NFL acknowledges the dangers of concussions; but not till the year of 2009 it acknowledges the severe effects of TBIs. I find it very distributing that is took this many years to discuss the long term effects of TBIs, just imagine how many football generations have passed, how many of them could of prevented the early onset of many diseases. Diseases such as depression, discussed in the article; mood changes (bipolar), early onset of Alzheimer’s, PBA (pseudobulbar affect) which is an extremely fascinating condition and many other neurological conditions. Medicine & Sports in Exercise & Science had an article about the direct relationship between recurrent TBIs and its coloration to depression: “TBI can result in diffuse lesions in the brain, depending on the mechanism of injury. These lesions result in biochemical changes, including an increase in excitatory neurotransmitters, which has been implicated in neuronal loss and cell death. A potential mechanism for lifelong depression could be this initial loss of neurons, which could be compounded by additional concussions, eventually leading to the structural changes seen with major depression.” (GUSKIEWICZ et all) The name of the article is: Recurrent Concussion and Risk of Depression in Retired Professional Football Players. It is a really good article.
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