B ~ U I N INJURY,
1992, VOL. 6, NO. 5 , 477-478
Letter to the Editors
Minor and severe head injury emotional sequelae
Brain Inj Downloaded from informahealthcare.com by Mcgill University on 11/19/14 For personal use only.
SUREYYA DIKMEN, RALPH M. REITAN, NANCY R . TEMKIN and J O A N E. MACHAMER Department of Rehabilitation Medicine, University of Washington, Seattle, USA Reitan Neuropsychology Laboratories, Tucson, Arizona, USA In a recent issue of Brain Injury Leininger, et al. examined the responses on the MMPI of 73 head-injured patients who had been referred for neuropsychological assessment on average five to three years after the injury [l]. The subjects were split into minor and severe groups based on initial head-injury severity. The results of the investigation revealed that these head-injured patients had elevated profiles on many of the subscales of the MMPI and the minor head-injured group had hgher elevations than the severe group. The authors conclude that minor head-injury patients are especially vulnerable to emotional difficulties post-injury or at least they fail to make clear distinctions between emotional difficulties in representative series of patients with minor head injury m. in those with complicated recoveries. The results of this study and the conclusions based on them are inconsistent with those based on prospective research on consecutive case admissions. Research on minor head-injury subjects consecutively admitted to a trauma centre and followed prospectively has demonstrated that the psychosocial sequelae of minor head injury are pronounced early after the injury. However, by one year post-injury, symptom reporting and endorsement of psychosocial problems decrease substantially and there are few significant . differences between minor head-injured and comparison groups [ 2 ] . Longitudinal examinations, using the MMPI in consecutive head injury admissions to a neurosurgcal service, reveal greater distress early after the injury, with decreasing levels of distress at 12 and 18 months post-injury. In addition, those with moderate or severe neuropsychological impairments implying more severe head injuries demonstrate greater distress on the MMPI than those with no or mild cognitive impairments suggesting mild head injuries [3]. The reason for the discrepancy between findings from research based on non-selected consecutive admissions and the findings of Leininger, et al. can be illuminated by examining the differences in the samples of patients studied. The minor head-injury sample studied by Leininger et al. represents a subgroup of patients that have not recovered and stayed in the health care delivery system, hence the late referral for rehabilitation services. The non-representativeness of their minor head-injured group is at least obvious from the gender distribution - 9 males and 20 females. Inclusion into their study was not based on the occurrence of head injury, but rather on the poor outcome. In the studies Address correspondence to: Sureyya Dikmen, Ph.D., Professor, Department of Rehabilitation Medicine (RJ-30), BB 941 Health Sciences Bldg., University of Washington, Seattle, WA 98195, USA. 0269-9052/92 $3.00 0 1992 Taylor 81 Francis Ltd.
Brain Inj Downloaded from informahealthcare.com by Mcgill University on 11/19/14 For personal use only.
478
Correspondence
based o n non-selected consecutive admissions to a trauma centre or neurosurgical service, iriclusion is based 011 the occurrence o f t h e head injury only. T h e findings of their study may merely reflect the reasons the cases stayed in the health care system and their inclusion in the study sample. Their results indicate that emotional distress or problems are overreprewnted in non-recovered minor head-injured cases without providing any infomianon about h o w commonly this occurs and the mechanisms responsible for these difficulties (e.g. direct result o f the brain injury o r reaction to other impairments sustained ILK pre-existing exnotional vulnerabilities vs. litigation). T h e findings of such patients represent the type of difficulties a fraction of patients with minor head injury experience and should not be generalized to the larger group of all patients with minor head injury. Inforniation o n this larger group is best obtained from prospective series ofconsecutive head injuries 12, 31. Cases such as those Leiriinger et al. describe provide a unique opportunity to study the characteristics of individuals w h o fail to recover in the expected time frame. For example, a carefully conducted casc-control study comparing individuals with minor head injury who have and have not recovered would allow the determination of risk factors for post-concussional syndronie and this, in turn, would help target early services to prevent poor outcome.
References LLININC;LK,U. E., KKEUTZEK, J. S. and HILL,M. R.: Comparison of Ininor and severe head injury emotional s q u e l a c using the MMPI. Brniri In j u r y, 5 : 199-205, 1991. 2. h w m , s., MCLEAN, A. and T E M K i N , N.: Neuropsychologcal and psychosocial consequences of minor head iiijuq. Joi(rnd o{.Ywroio~q.y,Srrrrostrrpry, mid Psychintry, 49: 1227-1 232, 1986. 3 . I I i m E N , S. and R ~ I I A N R.M.: , Emotional scquclae of traumatic head injury. Annals .f Xertrology. 2: -192-494. 1977 I.
ANNOUNCEMENT 2nd INTERNATIONAL NEUROTRAUMA SYMPOSIUM Mont
House H o t e l , Glasgotv, Scotland, UKJtrly 4th
- 9th
1Y93
C h a i r m a n and Secrctary:
Conference Secretanat, Meeting Makers, 50 Richmond Street, Glasgow, G1 1XP Scotland, UK
Professor G. Teasdaie (Chairman); Professor D. I. Graham (Secretary); Institute of Neurological Sciences, Southern General Hospital, Glasgow, G51 4 T F Scotland, UK
Tel: 041 553-1930 FAX: 041 552-0511
Tel: FAX:
Conference organization.
041 445-2466 Ext. 3740 041 425-1583
1992, VOL. 6, NO. 5 , 477-478
Letter to the Editors
Minor and severe head injury emotional sequelae
Brain Inj Downloaded from informahealthcare.com by Mcgill University on 11/19/14 For personal use only.
SUREYYA DIKMEN, RALPH M. REITAN, NANCY R . TEMKIN and J O A N E. MACHAMER Department of Rehabilitation Medicine, University of Washington, Seattle, USA Reitan Neuropsychology Laboratories, Tucson, Arizona, USA In a recent issue of Brain Injury Leininger, et al. examined the responses on the MMPI of 73 head-injured patients who had been referred for neuropsychological assessment on average five to three years after the injury [l]. The subjects were split into minor and severe groups based on initial head-injury severity. The results of the investigation revealed that these head-injured patients had elevated profiles on many of the subscales of the MMPI and the minor head-injured group had hgher elevations than the severe group. The authors conclude that minor head-injury patients are especially vulnerable to emotional difficulties post-injury or at least they fail to make clear distinctions between emotional difficulties in representative series of patients with minor head injury m. in those with complicated recoveries. The results of this study and the conclusions based on them are inconsistent with those based on prospective research on consecutive case admissions. Research on minor head-injury subjects consecutively admitted to a trauma centre and followed prospectively has demonstrated that the psychosocial sequelae of minor head injury are pronounced early after the injury. However, by one year post-injury, symptom reporting and endorsement of psychosocial problems decrease substantially and there are few significant . differences between minor head-injured and comparison groups [ 2 ] . Longitudinal examinations, using the MMPI in consecutive head injury admissions to a neurosurgcal service, reveal greater distress early after the injury, with decreasing levels of distress at 12 and 18 months post-injury. In addition, those with moderate or severe neuropsychological impairments implying more severe head injuries demonstrate greater distress on the MMPI than those with no or mild cognitive impairments suggesting mild head injuries [3]. The reason for the discrepancy between findings from research based on non-selected consecutive admissions and the findings of Leininger, et al. can be illuminated by examining the differences in the samples of patients studied. The minor head-injury sample studied by Leininger et al. represents a subgroup of patients that have not recovered and stayed in the health care delivery system, hence the late referral for rehabilitation services. The non-representativeness of their minor head-injured group is at least obvious from the gender distribution - 9 males and 20 females. Inclusion into their study was not based on the occurrence of head injury, but rather on the poor outcome. In the studies Address correspondence to: Sureyya Dikmen, Ph.D., Professor, Department of Rehabilitation Medicine (RJ-30), BB 941 Health Sciences Bldg., University of Washington, Seattle, WA 98195, USA. 0269-9052/92 $3.00 0 1992 Taylor 81 Francis Ltd.
Brain Inj Downloaded from informahealthcare.com by Mcgill University on 11/19/14 For personal use only.
478
Correspondence
based o n non-selected consecutive admissions to a trauma centre or neurosurgical service, iriclusion is based 011 the occurrence o f t h e head injury only. T h e findings of their study may merely reflect the reasons the cases stayed in the health care system and their inclusion in the study sample. Their results indicate that emotional distress or problems are overreprewnted in non-recovered minor head-injured cases without providing any infomianon about h o w commonly this occurs and the mechanisms responsible for these difficulties (e.g. direct result o f the brain injury o r reaction to other impairments sustained ILK pre-existing exnotional vulnerabilities vs. litigation). T h e findings of such patients represent the type of difficulties a fraction of patients with minor head injury experience and should not be generalized to the larger group of all patients with minor head injury. Inforniation o n this larger group is best obtained from prospective series ofconsecutive head injuries 12, 31. Cases such as those Leiriinger et al. describe provide a unique opportunity to study the characteristics of individuals w h o fail to recover in the expected time frame. For example, a carefully conducted casc-control study comparing individuals with minor head injury who have and have not recovered would allow the determination of risk factors for post-concussional syndronie and this, in turn, would help target early services to prevent poor outcome.
References LLININC;LK,U. E., KKEUTZEK, J. S. and HILL,M. R.: Comparison of Ininor and severe head injury emotional s q u e l a c using the MMPI. Brniri In j u r y, 5 : 199-205, 1991. 2. h w m , s., MCLEAN, A. and T E M K i N , N.: Neuropsychologcal and psychosocial consequences of minor head iiijuq. Joi(rnd o{.Ywroio~q.y,Srrrrostrrpry, mid Psychintry, 49: 1227-1 232, 1986. 3 . I I i m E N , S. and R ~ I I A N R.M.: , Emotional scquclae of traumatic head injury. Annals .f Xertrology. 2: -192-494. 1977 I.
ANNOUNCEMENT 2nd INTERNATIONAL NEUROTRAUMA SYMPOSIUM Mont
House H o t e l , Glasgotv, Scotland, UKJtrly 4th
- 9th
1Y93
C h a i r m a n and Secrctary:
Conference Secretanat, Meeting Makers, 50 Richmond Street, Glasgow, G1 1XP Scotland, UK
Professor G. Teasdaie (Chairman); Professor D. I. Graham (Secretary); Institute of Neurological Sciences, Southern General Hospital, Glasgow, G51 4 T F Scotland, UK
Tel: 041 553-1930 FAX: 041 552-0511
Tel: FAX:
Conference organization.
041 445-2466 Ext. 3740 041 425-1583
