Suchergebnisse

Background: There are no validated or agreed upon criteria for diagnosing chronic traumatic encephalopathy (CTE) in a living person. In recent years, it has been proposed that anger dyscontrol represents a behavioral clinical phenotype of CTE. This is the first study to examine the specificity of the diagnostic research criteria for traumatic encephalopathy syndrome (TES, the clinical condition proposed to be CTE) in men from the US general population who have anger dyscontrol problems. It was hypothesized that a substantial percentage of these men would meet the research criteria for TES. Methods: Data from 4,139 men who participated in the National Comorbidity Survey Replication, an in-person survey that examined the prevalence and correlates of mental disorders in the United States, were included in this study. Men who were diagnosed with intermittent explosive disorder in the past year were the clinical sample of interest (n = 206; 5.0% of all men in the database), and the remaining men were used as a comparison sample. They were classified as meeting the research criteria for TES if they presented with the purported supportive clinical features of CTE (e.g., impulsivity/substance abuse, anxiety, apathy, suicidality, headache). Results: In this sample of men from the general population with intermittent explosive disorder, 27.3% met a conservative definition of the proposed research criteria for CTE (i.e., traumatic encephalopathy syndrome). If one assumes the delayed-onset criterion is present, meaning that the men in the sample are compared to former athletes or military veterans presenting with mental health problems years after retirement, then 65.0% of this sample would meet the research criteria for TES. Conclusions: These results have important implications. Using conservative criteria, at least one in four men from the general population, who have serious anger control problems, will meet the symptom criteria for TES. If one considers former athletes and military veterans with anger control problems ...

Accumulation of phosphorylated tau (p-tau) is accepted by many as a long-term consequence of repetitive mild neurotrauma, based largely on brain findings in boxers (dementia pugilistica) and, more recently, former professional athletes, military service members, and others exposed to repetitive head trauma. The pathogenic construct is also largely accepted and suggests that repetitive head trauma (typically concussions or subconcussive forces) acts on brain parenchyma to produce a deleterious neuroinflammatory cascade, encompassing p-tau templating, trans-synaptic neurotoxicity, progressive neurodegenerative disease, and associated clinical features. Some caution before accepting these concepts and assumptions is warranted, however. The association between history of concussion and findings of p-tau at autopsy is unclear. Concussions and subconcussive head trauma exposure are poorly defined in available cases and the clinical features reported in CTE are not at present distinguishable from other disorders. Because control groups are limited, the idea that p-tau drives the disease process via protein templating or some other mechanism is preliminary. Much additional research in CTE is needed to determine if it has unique neuropathology and clinical features, the extent to which the neuropathologic alterations cause the clinical features, and whether it can be identified accurately in a living person.

Mild traumatic brain injuries (MTBIs) are common in sports, military service, and daily life. Limited data are available on the mental health needs of veterans with a history of MTBI who are seeking care in the community. The purpose of this article is to describe the mental health and psychosocial difficulties of a group of treatment-seeking veterans with a history of MTBI. The authors examined psychiatric comorbidities, psychosocial problems, and symptom burden in a cross-sectional sample of 129 treatment-seeking post-9/11 U.S. service members and veterans who reported a history of MTBI during a mental health evaluation at a nonprofit specialty outpatient clinic. The most common clinician-rated comorbid psychiatric diagnoses included posttraumatic stress disorder (N=113; 88%), major depressive disorder (N=57; 44%), alcohol use or abuse (N=56; 43%), and substance use or abuse (N=28; 22%). In addition, these service members and veterans endorsed high rates of anger and aggression, hazardous drinking, bodily pain, sleep difficulties, concentration problems, unemployment, and difficulties with family functioning. These clinical data suggest that post-9/11 service members and veterans who present with a history of MTBI represent a group of people who are highly symptomatic, have multiple comorbid conditions, and are struggling with multiple psychiatric, behavioral, and psychosocial difficulties. Clinical services designed to evaluate and treat these veterans should consider careful integration of mental health screening and services.