Psychiatric Symptoms Predict Recovery After Concussion

WASHINGTON — In the first month after a concussion, patients who display psychiatric symptoms, particularly after 7 days, were at increased risk for having a recovery that lasted longer than 1 month, according to new findings.

Arun S. Chhabra, MD, of Rush University Medical Center in Chicago, and fellow researchers conducted the study, which was presented at the 2015 American Academy of Neurology Annual Meeting.
“Our study shows the importance of screening for psychiatric manifestations of post-concussive syndrome,” Chhabra said in an interview with Neurology Advisor. “And by screening, you can help not only shorten recovery from and treat psychiatric manifestations, but it also benefits patients and their families to know that this may be part of the process, and, if so, it will make the recovery longer.”

In all, Chhabra and colleagues retrospectively analyzed 436 concussion or post-concussive syndrome patients (age range, 16-75 years) culled from Rush University’s general neurology and sports medicine clinics between January 2012 and April 2014.

All patients experienced a concussion within 4 months of clinic visit and were excluded if they had a previous diagnosis of a psychiatric illness or had an intracranial hemorrhage or skull fracture at the time of concussion.

Researchers compared patients with psychiatric symptoms — defined as irritability, depression, anxiety, or mood changes — that occurred at different times within 1 month of the concussion with patients who did not experience psychiatric symptoms.

The final analysis included 77 patients, of who 26 displayed psychiatric symptoms between 7 to 30 days after concussion. Among those who did not display psychiatric symptoms during this timeframe (n=51), 29.4% recovered from their concussion at 1 month compared with just 7.7% of those who had psychiatric symptoms (P=.03).

This relationship remained in multivariate analysis adjusting for age and gender (OR=0.19; 95% CI, 0.04-1; P=0.05).

After including patients who had psychiatric symptoms in the first 7 days after the concussion, there was a trend indicating an increased risk for prolonged recovery, although this did not reach statistical significance (P=0.11).

According to Chhabra, most concussions, roughly 80% to 90%, are resolved within a week, which is why the primary analysis looked at 7 to 30 days after the concussion occurred.
“And the cases that are not resolved in the first week warrant more attention from physicians, subspecialists, trainers, etc.,” he said.
Although it will require another study for confirmation, Chhabra added he has seen the benefits of referring post-concussive patients to psychiatrists or psychologists.
“There is a window … within which we can screen for and treat these psychiatric manifestations. And the quicker we treat them, the better the recovery overall from the concussion,” he said.

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