Kristensen Mckenzie (donkeyrugby11)

OBJECTIVE Clarify associations between diagnosis of posttraumatic stress disorder (PTSD) and deployment traumatic brain injury (TBI) on salient regional brain volumes in returning combat veterans. PARTICIPANTS Iraq and Afghanistan era combat veterans, N = 163, 86.5% male. MAIN MEASURES Clinician-administered PTSD Scale (CAPS-5), Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), magnetic resonance imaging. METHODS Hierarchical regression analyses evaluated associations and interactions between current and lifetime PTSD diagnosis, deployment TBI, and bilateral volume of hippocampus, anterior cingulate cortex, amygdala, orbitofrontal cortex, precuneus, and insula. RESULTS Deployment TBI was associated with lower bilateral hippocampal volume (P = .007-.032) and right medial orbitofrontal cortex volume (P = .006). Neither current nor lifetime PTSD diagnosis was associated with volumetric outcomes beyond covariates and deployment TBI. CONCLUSION History of deployment TBI is independently associated with lower volumes in hippocampus and medial orbitofrontal cortex. These results support TBI as a potential contributing factor to consider in reduced cortical volume in PTSD.OBJECTIVE Lack of evidence for efficacy and safety of treatment and limited clinical guidance have increased potential for undertreatment of depression following traumatic brain injury (TBI). METHODS We conducted a retrospective cohort study among individuals newly diagnosed with depression from 2008 to 2014 to assess the impact of TBI on receipt of treatment for incident depression using administrative claims data. PLX3397 nmr We created inverse probability of treatment-weighted populations to evaluate the impact of TBI on time to receipt of antidepressants or psychotherapy following new depression diagnosis during 24 months post-TBI or matched index date (non-TBI cohort). RESULTS Of 10 428 individuals with incident depression in the TBI cohort, 44.7% received 1 or more antidepressants and 20.0% received 1 or more psychotherapy visits. Of 10 463 in the non-TBI cohort, 41.2% received 1 or more antidepressants and 17.6% received 1 or more psychotherapy visits. TBI was associated with longer time to receipt of antidepressants compared with the non-TBI cohort (average 39.6 days longer than the average 126.2 days in the non-TBI cohort; 95% confidence interval [CI], 24.6-54.7). Longer time to psychotherapy was also observed among individuals with TBI at 6 months post-TBI (average 17.1 days longer than the average 47.9 days in the non-TBI cohort; 95% CI, 4.2-30.0), although this association was not significant at 12 and 24 months post-TBI. CONCLUSIONS This study raises concerns about the management of depression following TBI.OBJECTIVE To better identify variables related to discrepancies between subjective cognitive complaints and objective neuropsychological findings in persons with traumatic brain injury (TBI). SETTING Three rehabilitation centers in the United States. PARTICIPANTS In total, 504 community-dwelling adult survivors of TBI following discharge from inpatient rehabilitation. DESIGN Prospective cohort observation study. MAIN MEASURES Wechsler Adult Intelligence Scale, Fourth Edition, Digit Span; Rey Auditory Verbal Learning Test; Trail Making Test, Part B; Word Memory Test; Patient Health Questionnaire-9; Neurobehavioral Symptom Inventory; TBI-Quality of Life item bank. RESULTS Statistical analyses revealed multiple factors associated with subjective-objective discrepancies in attention, memory, and executive functions. Depression was consistently associated with underestimation of cognitive abilities. However, subjective-objective discrepancies varied by cognitive domains in regard to other factors related to underestimation and overestimation of abilities. CONCLUSIONS Reconciling and interpreting subjective-objective discrepancies regarding cognitive functions following TBI are important tasks for case conceptualization and treatment planning. Depression