Chronic traumatic encephalopathy (CTE) has become an important new condition in neuropsychiatry. As a type of traumatic brain injury (TBI), CTE specifically occurs with repeated concussive or subconcussive impacts typically seen in high-impact sports or in modern warfare. It is seen now in athletes such as American football players, hockey players, and in boxers, as well as recent military veterans exposed to high-impact explosives, such as bombs. The symptoms of CTE include initial mood psychopathology, such as depression and manic iimpulsivity, with mild cognitive impairment that eventually worsens to full dementia. Suicidality also occurs and worsens, with notable cases of suicide. The scope of risk of CTE is unknown, such as whether it can be present after just a few years of high-impact athletic or military exposure, or requires a longer incubation. The frequency of CTE is debated, with post-mortem studies ranging from over 90% prevalence to lower rates.

No defined diagnostic or treatment approaches to CTE have been developed, other than post-mortem brain autopsy, which shows severe tauopathy. Recent studies on diagnosis will be reviewed, as well as possible treatment approaches, including lithium as a potential agent for mood, suicidality, and dementia prevention.

**This content was captured at the 2019 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.

Course References

• Falcon, B., Zivanov, J., Zhang, W. et al. Novel tau filament fold in chronic traumatic encephalopathy encloses hydrophobic molecules. Nature 568, 420–423 (2019) doi:10.1038/s41586-019-1026-5

• Woerman, A. L., Aoyagi, A., Patel, S., Kazmi, S. A., Lobach, I., Grinberg, L. T., … Prusiner, S. B. (2016). Tau prions from Alzheimer’s disease and chronic traumatic encephalopathy patients propagate in cultured cells. Proceedings of the National Academy of Sciences, 113(50), E8187–E8196. https://doi.org/10.1073/pnas.1616344113

Learning Objectives

• Examine the origins and meaning of the concept of chronic traumatic encephalopathy (CTE)
• Review recent studies on the psychopathology of CTE
• Explore possible treatments for the psychiatric aspects of CTE, especially mood and suicidality

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 60 minutes
Begin Date: September 1, 2020
End Date: September 1, 2023

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Program Presenters

• Sivan Mauer, M.D., MSc., Research psychiatrist, Tufts University School of Medicine, Boston. Reports no financial relationships with commercial interests.
• Nassir Ghaemi, M.D., MPH, Director of the Mood Disorder Program and the Psychopharmacology Consultation Clinic at Tufts Medical Center. Disclosures - Employment: Novartis (Self).
• Amanda Woerman, PhD, Assistant Professor at University of Massachusetts Amherst. Disclosures - Other: A patent application was submitted pertaining to the work presented.

Program Planners

• Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance