Abstract: Since the early 20th century, when large numbers of World War I veterans returned from front lines with “shell shock,” there has been significant controversy regarding the nature of postconcussive symptoms that persist or emerge after a mild traumatic brain injury (mTBI). Symptoms such as headache, nausea, and blurry vision were originally thought to resolve in the first 7–10 days after injury for the vast majority (80%–90%) of individuals. More recent studies indicate that symptoms will persist in a significant minority of cases, with functional impairment in up to 33% at 3 months and 22% at 1 year, as recently described in a report from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) research group. The pace and extent of recovery from mTBI are now understood to vary considerably depending on patient and injury characteristics, and recovery may take 6 months or longer. A predominant historical view holds that prolonged postconcussive symptoms represent a phenomenon with significant somatoform features that may have been present before the injury or may emerge well after the injury and that resemble the nonspecific symptoms experienced after any type of bodily trauma. However, more contemporary research suggests that multiple etiologies contribute to prolonged postconcussive symptoms, including psychogenic factors (e.g., coping style and mood and anxiety disorders), cervicogenic factors (e.g., neck injury), and neurophysiological causes (e.g., cerebrovascular dysregulation, microscopic white matter damage). As mTBI is a significant public health issue, with an estimated 42 million mTBIs sustained worldwide every year, even a conservative estimate of the prevalence of prolonged postconcussive symptoms (10%–15% of mTBIs) suggests a substantial unrecognized burden of hundreds of thousands of new patients with such symptoms each year.
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The participant will compare treatment recommendations for patients with postconcussive symptoms following a mild traumatic brain injury.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Estimated Time to Complete
Duration: 1 hour
Begin Date: February 1, 2018
End Date: January 31, 2020
How to Earn Credit
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive 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 journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
Title: Prolonged Postconcussive Symptoms
Authors: Davin K. Quinn, M.D., Andrew R. Mayer, Ph.D., Christina L. Master, M.D., Jesse R. Fann, M.D., M.P.H.
Affiliations: From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque (D.K.Q., A.R.M.); the Department of Pediatrics and the Division of Orthopedics and Sports Medicine, Children’s Hospital of Philadelphia, Philadelphia (C.L.M.); and the Department of Physical Medicine and Rehabilitation, University of Washington, Seattle (J.R.F.).
Disclosures: Dr. Fann has served as a consultant for Quartet Health. The other authors report no financial relationships with commercial interests.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Robert Freedman, M.D. (Editor-in-Chief, AJP); Susan K. Schultz, M.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).
Dr. Schultz has received research support from the Alzheimer’s Disease Cooperative Study for projects conducted in partnership with Toyama Chemical Company and in partnership with Eli Lilly and Company. Dr. Freedman, Mr. Roy, and Mr. Pogachar report no financial relationships with commercial interests.
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