4. 10 POSTCONCUSSIONAL SYNDROME
The postconcussional syndrome (PCS)
refers to the emergence and variable persistence of a group of symptoms
following head injury, particularly mild head injury. Most descriptions
include somatic symptoms (headache, dizziness, fatigability, nausea,
vomiting, drowsiness, blurred vision, diplopia, insomnia, poor hearing,
hypersensitivity to noise and appetite changes) accompanied by
psychological symptoms, both cognitive (poor memory and concentration) and
affective (reduced tolerance for frustration, irritability, emotional
lability, depression and anxiety).
A third to a half of patients
experiences the syndrome over the first few weeks after mild head injury.
While most become asymptomatic in the ensuing months, a substantial
minority experiences persistent symptoms six months to a year later
(Fenton et al., 1993). Jacobson (1995) describes a number of mechanisms
that may interact in the emergence and persistence of PCS, and these
include organic, psychogenic, and motivational factors; operant
conditioning, psychophysiologic stress responses, and cognitive behavioral
factors. Lishman (1988) concluded that physiological factors contributed
mainly to the onset of PCS, while psychological factors contributed more
to its long term course. Alexander (1995) highlighted that patients who
develop prolonged PCS are (1) more likely to have been under stress at the
time of the accident, (2) develop depression and / or anxiety soon after
the accident, (3) have extensive social disruptions after the accident,
and (4) have problems with physical symptoms such as headache and
dizziness.
Interventions for prevention of PCS
include provision of information, education about understanding and
predicting symptoms and their resolution, and active management of a
gradual process of return to functioning. It is important to involve the
patient’s family or significant other so that they understand the disorder
and predicted recovery. After the PCS has developed, the clinician must
develop an alliance with the patient and validate his or her experience of
cognitive and emotional difficulties, while not prematurely confronting
emotional factors as primary. A combined treatment strategy that addresses
both the emotional problems and the cognitive problems is required (Kay,
1993). Sertraline was found useful in treatment of depressive and
postconcussive symptoms in a group of depressed patients with a history of
mild TBI (Fann et al., 1996). |
