Symptoms Following Mild Brain Injury: PCS or PTSD?

the Psychiatry Advisor take:

Some patients who experience mild traumatic brain injury experience symptoms long after the trauma occurred. Some mental health professionals have called for the prolonged experience of symptoms to be known as postconcussion syndrome (PCS), which his already included in DSM-IV. However, there is debate over whether PCS should be called such a syndrome, or whether it is simply part of posttraumatic stress disorder (PTSD).

Researchers at the University of Bordeaux and the French Institute of Health and Medical Research sought to figure out whether symptoms that are still experienced three months after brain injury should be classified as PCS or PTSD-related.

Emmanuel Lagarde, PhD, and colleagues, conducted a prospective cohort study of patients from the emergency department of the University Hospital of Bordeaux. Included were 534 patients with head injury and 827 control patients with other nonhead injuries.

Three months following the trauma, 21.2% of head-injured and 16.3% of nonhead-injured patients fulfilled the DSM-IV diagnosis of PCS; 8.8% of head-injured patients fulfilled the diagnostic criteria for PTSD compared with 2.2% of control patients. In multivariate analysis, MTBI was a predictor of PTSD (odds ratio, 4.47; 95% Confidence Interval, 2.38-8.40) but not of PCS (odds ratio, 1.13; 95% CI, 0.82-1.55).

Correspondence analysis suggested that symptoms considered part of PCS behave similarly to PTSD symptoms in the hyperarousal dimension. None of these 22 symptoms showed any pattern of clustering, and no clear proximity with head or nonhead injury status could be found.

“Persistent subjective symptoms frequently reported 3 months after MTBI are not specific enough to be identified as a unique PCS and should be considered part of the hyperarousal dimension of PTSD,” Lagarde and his colleagues concluded.

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Symptoms Following Mild Brain Injury: PCS or PTSD?

A proportion of patients experience long-lasting symptoms following mild traumatic brain injury (MTBI). The postconcussion syndrome (PCS), included in the DSM-IV, has been proposed to describe this condition. Because these symptoms are subjective and common to other conditions, there is controversy whether PCS deserves to be identified as a diagnostic syndrome.

The objective of the study is to assess whether persistent symptoms 3 months following head injury are specific to MTBI or whether they are better described as part of posttraumatic stress disorder (PTSD).


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