Objective
To investigate the risk of psychiatric disorders following TBI, and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders.
Posts Tagged psychiatric disorders
[NEWS] Functional seizures associated with stroke psychiatric disorders
Posted by Kostas Pantremenos in Epilepsy on January 18, 2021
Washington [US], January 8 (ANI): In a large-scale study of electronic health records, Vanderbilt University Medical Center investigators have determined the prevalence of functional seizures and characterized comorbidities associated with them.
Functional seizures are sudden attacks or spasms that look like epileptic seizures but do not have the aberrant brain electrical patterns of epilepsy.
The research team, headed by Lea Davis, PhD, associate professor of Medicine and an investigator in the Vanderbilt Genetics Institute, confirmed associations between functional seizures and psychiatric disorders including posttraumatic stress disorder, anxiety and depression as well as sexual assault trauma.
They also discovered a novel association between functional seizures and cerebrovascular disease, including stroke.
The findings were reported in the journal JAMA Network Open.
Also known as psychogenic nonepileptic seizures, functional seizures have been historically understudied. Patients often experience a long delay — on average seven years — before they receive an accurate diagnosis.
About 80 per cent of patients experiencing functional seizures are initially misdiagnosed with epilepsy and treated with anti-epileptic drugs, said Slavina Goleva, a graduate student in Molecular Physiology and Biophysics and first author of the study. An accurate diagnosis requires assessment with video electroencephalogram (EEG).
Davis got interested in functional seizures after hearing an NPR story several years ago.
“The story gave the patient perspective on these seizures — the stigma that patients felt and the difficulties they experienced in the medical system. I felt like studies within electronic health records could potentially be really impactful for this community,” Davis recalled.
Working with Kevin Haas, MD, PhD, associate professor of Neurology, the researchers developed an algorithm to identify people with functional seizures in the VUMC-EHR system.
“We initially recognized that finding these patients within the EHR would be a challenge because the ICD (International Classification of Diseases) codes are not as specific as they are for a lot of diseases,” Goleva said.
In addition to ICD codes, the researchers included Current Procedural Terminology (CPT) codes and used natural language processing to search within the records for a list of keywords.
Goleva and Haas manually reviewed charts to confirm that the algorithm correctly identified patients with functional seizures.
The study included more than 2.3 million patients 18 or older in the VUMC-EHR system from 1989 to 2018. The researchers identified 3,341 patients with functional seizures, 74 per cent of whom were women. They calculated a prevalence of 0.14 per cent (140 cases per 100,000 people); previous estimates ranged from 2 to 33 cases per 100,000 people.
“Our report is the first direct calculation of the prevalence of functional seizures,” Goleva said.
She noted that the epilepsy monitoring unit at VUMC may result in a higher prevalence of functional seizures in patients in the VUMC-EHR compared to the general population.
Among the patients with functional seizures, the researchers validated comorbidities including psychiatric disorders and sexual assault trauma and discovered a novel association with cerebrovascular disease. They also found that sexual assault trauma explained about a quarter of the increased rate of functional seizures among women, Goleva said.
“Functional seizures are not occurring in isolation; patients who are experiencing these seizures are also experiencing a higher burden of additional health care issues,” Davis said.
“If there is a suspicion that someone presenting with seizures could have functional seizures rather than epileptic seizures, it’s critical to refer those patients to an epilepsy monitoring unit for accurate diagnosis and appropriate treatment,” Haas said.
“Historically, even once diagnosed, care of these patients has often fallen through the cracks between neurology and psychiatry, but we are now actively developing a more integrated approach to care for this patient population,” Haas added.
The researchers recommended that patients experiencing seizures who have psychiatric comorbidities or a history of sexual assault trauma be referred for video-EEG assessment.
Patients who develop seizures after a stroke and do not initially respond to treatment with medications should also be considered for early video-EEG assessment.
Up to 30 per cent of patients referred for video-EEG are eventually diagnosed with functional seizures, they noted.
“It’s frustrating that there is no ICD code for functional seizures, given how common the diagnosis is and the fact that codes exist for strange things like alligator bite, second occurrence,” Davis said.
“It really emphasizes how little attention this population of patients has gotten,” added Davis.
The investigators are currently exploring the genetics of functional seizures using genome-wide association studies of biobanks including Vanderbilt’s BioVU. (ANI)
Disclaimer: The views expressed in the article above are those of the authors’ and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.
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[Absttract + References] Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies – Archives of PMR
Posted by Kostas Pantremenos in Cognitive Rehabilitation, REHABILITATION, TBI on October 7, 2020
Abstract
Objective
To investigate the risk of psychiatric disorders after traumatic brain injury (TBI), and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders.
Design
A register-based, retrospective cohort design.
Setting
Using data from the National Health Insurance Research Database of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015.
Participants
This study included 231,894 patients with TBI and 695,682 patients without TBI (N=927,576).
Interventions
Rehabilitation therapies in TBI patients.
Main Outcome Measures
A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders.
Results
The incidence rate of psychiatric disorders was higher in the TBI group than the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (hazard ratio [HR]=2.072; 95% confidence interval [95% CI], 1.955-2.189; P<.001). Among the participants with TBI, 49,270 (21.25%) had received rehabilitation therapy and had a lower risk of psychiatric disorders (HR=0.691; 95% CI, 0.679-0.703; P<.001). In the subgroup analysis, the medium- to high-level intensity rehabilitation therapy was associated with lower risks of psychiatric disorder (HR=0.712 and 0.568, respectively), but there was no significant finding in the low-intensity group.
Conclusions
We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.
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Source: https://www.archives-pmr.org/article/S0003-9993(19)31501-1/fulltext
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[Abstract] Psychiatric disorders following traumatic brain injury: a nationwide population-based cohort study and the effects of rehabilitation therapies
Posted by Kostas Pantremenos in REHABILITATION, TBI on January 8, 2020
Abstract
Design
A register-based, retrospective cohort design
Setting
Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015.
Participants
This study included 231,894 patients with TBI and 695,682 controls.
Interventions
Rehabilitation therapies in TBI patients.
Main Outcome Measures
A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders.
Results
The incidence rate of psychiatric disorders was higher in the TBI group when compared with the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (HR=2.056, 95% CI:1.940- 2.172, p < 0.001). Among the TBI subjects, 49,270 (21.25%) had received rehabilitation therapy and had a lower risk of psychiatric disorders (HR=0.691, 95% CI: 0.679-0.703, p < 0.001). In the subgroup analysis, the medium- to high-level intensity rehabilitation therapy was associated with lower risks of psychiatric disorder (HR=0.712 and 0.568, respectively), but there was no significant finding in the low-intensity group.
Conclusions
We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.
TBI Rehabilitation 