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A retrospective descriptive study (n = 44) was conducted on the response styles of post-acute traumatic brain-injured patients on the MMPI. The sample profiles were examined on indices of consistency, random responding, and bias to look good or bad. The results showed that about 20% of the profiles were markedly inconsistent, including two profiles which met the criteria for random responding. Depending on the cut-off score used, between 0 and 9% were identified as biased to look bad, while between 18 and 30% were identified as biased to look good. A mean profile on the primary clinical and research scales was developed and a frequency count of the high two-point codes was conducted. This profile approached clinically significant levels on the Psychopathic deviant, Schizophrenia, Depression, and Mania scales, respectively. The three most frequently occurring two-point codes (2-4, 4-8, and 4-9) have been classified as characterological in nature. The primary implication of these results for clinicians was the need for careful scrutiny of indices of consistency, random responding and bias to look good when interpreting self-report measures such as the MMPI with the TBI population.
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PMID:The response styles of post-acute traumatic brain-injured patients on the MMPI. 292 37

This study examined the relationship of patient variables to caregiver distress and family functioning after TBI in 62 families. An extension of Kreutzer et al. 1994 (in press), the present investigation used four categories of predictor variables: indices of injury severity, neuropsychological tests, neurobehavioural problem checklist scales, and kinship of caregiver (i.e. spouse vs. parent). Caregiver distress and family functioning were measured by the Brief Symptom Inventory (BSI) and Family Assessment Device (FAD), respectively. Regression analyses revealed that indices of injury severity did not predict BSI scores. Time post-injury predicted several FAD subscales. The number of the patient's neurobehavioural problems predicted BSI subscale scores most consistently, particularly the Global Severity Index, Somatic, Obsessive-Compulsive and Depression scales. Scores on the behaviour problem subscale predicted BSI scores better than other kinds of problems, and also had some relation to several FAD subscales. Of the 10 neuropsychological test scores, those which measured verbal abilities were more predictive of caregiver's BSI scores. Kinship (i.e. being a spouse) predicted Depression scores, even when other variables were partialled out. Research findings are integrated with European studies and clinical implications for understanding caregiver distress are discussed.
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PMID:Patient correlates of caregivers' distress and family functioning after traumatic brain injury. 800 78

In this study, self-reported symptoms (cognitive, physical, behavioural/affective) from the TIRR Symptom Checklist are compared across six panels: 135 individuals with mild TBI, 275 with moderate/severe TBI, 287 with no disability, 104 with spinal cord injury, 197 who are HIV positive and 107 who had undergone liver transplantation. Participants with TBI and SCI were at least 1 year post-injury. Individuals with TBI reported significantly more symptoms than other panels. Symptom reports in the TBI panels were independent of demographic variables (gender, education, income, ethnicity, age), as well as time since injury and depression. Five of the 67 symptoms were found to be sensitive/specific to TBI in general; 25 symptoms were sensitive/specific to mild TBI (23 were cognitive, one physical and one behavioural/affective). Implications of these results in terms of current debates about the 'reality' of symptom reports in individuals with mild TBI are discussed, as well as implications for using symptom checklists for TBI screening.
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PMID:The sensitivity and specificity of self-reported symptoms in individuals with traumatic brain injury. 1067 Jun 59

The possibility that patients who have suffered a traumatic brain injury will commit suicide is high, and in many cases clinicians tend to underestimate this possibility. In this study, 39 consecutive patients are studied through a Rorschach technique more than 1.5 years after their hospital discharge. The data show that 48.6% of the patients fulfil the criteria that classifies them as depressive, and, of these, 65% are at clinical risk to commit suicide (33.3% of the total of TBI patients); 25.6% have not met the criteria of depression or suicidal tendencies, and another 25.6% show very low suicide tendency scores. Only 15.6% of the total patients presented only depression without risk of suicide. The neurobehavioural and cognitive profile of the TBI suicide-prone patient shows an emotional person with cognitive difficulties in how they interpret reality, the person tries to understand what is happening around them, but is unable to cope. They show concrete thoughts, although they have difficulties solving problems and have few intellectual resources to cope with their surroundings. They do not know how to distance themselves from the emotional aspects of situations.
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PMID:Neurobehavioural and cognitive profile of traumatic brain injury patients at risk for depression and suicide. 1126 Jul 67

Recent research has shown that cancer patients undergoing bone marrow transplantation (BMT) experience moderate to severe mouth pain due to treatment-related mucositis in spite of morphine therapy. Treatment-related emotional distress in BMT patients is also described widely. This study examined several biomedical, psychological and social variables as possible predictors for the intensity of treatment-related mouth pain and anxious mood in 63 cancer patients undergoing BMT or stem cell transplantation (SCT) within a prospective longitudinal design. Biomedical predictors included biomedical risk, mucositis, the mode of transplantation, total body irradiation, age and gender. Psychological predictors were depression (BDI), BMT-related distress, chronic stress and resources in everyday life (KISS), pain-related coping behaviour (KPI-17) and social support (ISSS). Among the social variables we evaluated education, being married and the living situation. Criteria variables were the intensity of mouth pain and anxious mood which were assessed daily by numeric self-rating scales for 24 days after transplantation. Results of stepwise multiple regressions indicated that psychological and social variables were important predictors of mouth pain, besides biomedical variables. Whereas the biomedical variables revealed the most predictive power during the second week after BMT, psychological predictors were more important during the early and late phases of the treatment. Daily anxious mood was best predicted by psychological and social variables. Among the biomedical variables mucositis was most strongly related to mouth pain besides mode of transplantation, risk, TBI and age. Among the psychological variables BMT-related distress was the most important predictor, with resources in private life or at work and pain-related coping modes as further significant predictors. These results imply that relevant predictors should be assessed as high risk factors for an increased vulnerability for treatment-related side-effects before treatment starts indicating an additional offer of psychological treatment in high risk patients.
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PMID:The role of biomedical and psychosocial factors for the prediction of pain and distress in patients undergoing high-dose therapy and BMT/PBSCT. 1189 32

The ability of 23 previously identified Minnesota Multiphasic Personality Inventory (MMPI) "neurologic content" items to distinguish between individuals with traumatic brain injury (TBI; n = 32) or spinal cord injury (SCI; n = 17) was examined. Principal-components analysis of the 23 items revealed three conceptually coherent, nonoverlapping, and uncorrelated factors (Cognitive, Somatic, Inactivity) that together accounted for 44% of the total variance. Coefficients of internal consistency for the factors were in the moderate to high range. Together, the factors were named the Revised Neurobehavioral Scales of the MMPI. The group with TBI scored significantly higher on the Cognitive scale and significantly lower on the Inactivity scale than the group with SCI (with or without depression as a covariate). The Glasgow Coma Scale correlated significantly and negatively with the Cognitive scale in the group with TBI. Discriminant function analysis revealed that together the scales correctly classified individuals with sensitivity and a positive predictive value (with respect to TBI) of 87% and 81%, respectively. Specificity and a negative predictive value (with respect to SCI) were 68% and 76%, respectively. The overall rate of correct classification of individual cases was 80% (with or without depression in the analysis). The Cognitive scale alone correctly classified individuals in the group with TBI with a positive predictive value of 84%. Findings are discussed in terms of the discriminative validity and potential utility of TBI-related MMPI items, as well as the issue of "neurocorrection" of the MMPI (or MMPI-2) in verified cases of TBI.
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PMID:Revised neurobehavioral scales of the MMPI: sensitivity and specificity in traumatic brain injury. 1613 41

Victims of mild traumatic brain injury (mTBI) do not show clear morphological brain defects, but frequently suffer from long-lasting cognitive deficits, emotional difficulties and behavioral disturbances. In the present study, we investigated the effects of experimental mTBI in mice on cognition, spatial and non-spatial tasks, and depressive-like behavior in mice. Experimental brain injury was induced using a concussive head trauma, which creates the TBI by a weight-drop device. Different groups of mice were tested at 7, 30, 60, and 90 days post-injury for cognitive function (the swim T-maze and the passive avoidance test) and for depression-like behavior (the forced swimming test). These tests have been used infrequently in the past in mTBI research. Significant differences were observed between the injured mice compared to the controls in both the swim T-maze (day 30: p < 0.001) and passive avoidance (day 30: p < 0.05) tests. In addition, a significant difference was detected in the forced swimming test between the injured mice and the controls (day 7: p < 0.05; day 90: p < 0.01), which showed a depressive- like state in the injured animals beginning 7 days post-injury. These results demonstrate that persistent deficits in these tests of cognitive learning abilities and emergence of depressive-like behavior in injured mice are similar to those reported in human post-concussion syndrome.
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PMID:Mild traumatic brain injury induces persistent cognitive deficits and behavioral disturbances in mice. 1615 15

Victims of minor traumatic brain injury (mTBI) can show long lasting cognitive, emotional and concentration difficulties, amnesia, depression, apathy and anxiety. The symptoms are generally known as a post-concussive syndrome without clear morphological brain defects. Endogenous opiates are released after impact to the brain, suggesting they may play a role in TBI pathophysiology. Furthermore, the administration of opiates to the brain of injured animals has been shown to affect the injury, induce cellular changes and also have protective qualities for neurological impairments. Here, we examined the protective properties of the opiate morphine on cognitive performances following minimal brain injury in mice. For this purpose, we have used our non-invasive closed-head weight drop model in mice, which closely mimics real life mTBI and examined mice performance in the Morris water maze. Our procedure did not cause visible structural or neurological damage to the mice. A single morphine injection administrated immediately after the induction of minimal TBI protected the injured mice from cognitive impairment, checked 30, 60 and 90 days post injury. However, mice injected with morphine that were examined 7 days after the injury did not show better performance than the saline injected mice. Our results indicate that morphine has long but not short-term effects on the cognitive ability of brain-injured mice. Although the exact nature of opioid neuroprotection is still unknown, its elucidation may lead to the much-needed treatment for traumatic brain injury.
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PMID:Morphine protects for head trauma induced cognitive deficits in mice. 1635 39

MMPI-2 maintains an extensive empirical base with psychiatric populations, although more recently, neurologically compromised patients have documented unique elevation patterns. This study examined mild-moderate TBI patients, Alzheimer's Dementia patients, and Psychiatric controls on MMPI-2 scales. Participants included 160 outpatients (TBI n = 26, AD n = 74, Psychiatric n = 60). Controlling for family-wise-error, five ANCOVAs were conducted on five MMPI-2 scales, correcting for age and education. TBI and Psychiatric group means were significantly higher than AD group means for scales Hypochondriasis, Depression, and Hysteria at an alpha of .01. Results support previous research with mild TBI patients, and further document a unique pattern of elevations in this population.
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PMID:Can the MMPI-2 discriminate between mild-moderate TBI and other neurologic and psychiatric populations? 1714 74

Fifty-three adults who had received SCT as children responded to questionnaires on health-related quality of life (HRQoL) (Swedish HRQoL survey (SWED-QUAL)), sense of coherence (SOC), anxiety and depression (HAD) and a health and symptom inventory. Late effects were classified following the Common Terminology Criteria for Adverse Events (CTCAE) v. 3.0. HRQoL was below norm in 9 of 13 SWED-QUAL domains. Poorest domains (P<0.001) were satisfaction with physical health, general health, partner relations and sexual function, whereas emotional wellbeing and satisfaction with family life were on par with the norm. Older age, time elapsed post-SCT and fewer self-reported symptoms correlated with better HRQoL. Unfavourable late effect scores had no or limited impact, whereas age at SCT or TBI did not adversely affect HRQoL. Most subjects were well subjectively and objectively, whereas 24% had more complicated late effects. The median Karnofsky score was 90, 13% of subjects having scores below 80. In total, 53% reported pain, whereas 42.5% had memory and concentration problems. Anxiety and/or depression, reported by 35%, were associated with lower HRQoL and SOC ratings. Overall, 55% reported infertility and expressed difficulty with this. To conclude, childhood SCT did not negatively affect overall health for most of these adult long-term survivors, although poorer HRQoL with psychological and cognitive problems are common.
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PMID:Health-related quality of life in adult survivors after paediatric allo-SCT. 1932 31


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