Research papers on post-concussion syndrome (PCS) and psychological factors

Looking for the original post? It’s moved here – – to my brain injury research blog.

Author: brokenbrilliant

I am a long-term multiple (mild) Traumatic Brain Injury (mTBI or TBI) survivor who experienced assaults, falls, car accidents, sports-related injuries in the 1960s, '70s, '80s, and '90s. My last mild TBI was in 2004, but it was definitely the worst of the lot. I never received medical treatment for my injuries, some of which were sports injuries (and you have to get back in the game!), but I have been living very successfully with cognitive/behavioral (social, emotional, functional) symptoms and complications since I was a young kid. I’ve done it so well, in fact, that virtually nobody knows that I sustained those injuries… and the folks who do know, haven’t fully realized just how it’s impacted my life. It has impacted my life, however. In serious and debilitating ways. I’m coming out from behind the shields I’ve put up, in hopes of successfully addressing my own (invisible) challenges and helping others to see that sustaining a TBI is not the end of the world, and they can, in fact, live happy, fulfilled, productive lives in spite of it all.

4 thoughts on “Research papers on post-concussion syndrome (PCS) and psychological factors”

  1. Thanks – I did a quick review from those links but didn’t see anything that said PCS symptoms were only the result of an underlying psychological condition. Here is what I found..

    Review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. – I think that is a reasonable connection

    Our results suggest that the post-concussion syndrome is associated with specific abnormalities in functional brain network that may contribute to explain deficits typically observed in PCS patients. – this was established using neurofeedback.

    Though a consensus has not been reached on the cause of long-term PCS, it is likely that biological, physiological, psychological, and social elements all play a role in symptom persistence. Additionally, persistent PCS may adversely affect one’s developmental trajectory. – again nothing to disagree with.

    Ongoing symptoms are either a prolonged version of the concussion pathophysiology or a manifestation of other processes, such as cervical injury, migraine headaches, depression, chronic pain, vestibular dysfunction, visual dysfunction, or some combination of conditions. The pathophysiology of ongoing symptoms from the original concussion injury may reflect multiple causes: anatomic, neurometabolic, and physiologic. – again, nothing to disagree with

    The results of this prospective study suggest that headache right after the head injury, an alteration of consciousness after the head injury, and alcohol consumption prior to the head injury are significant predictors of developing PCS, which occurs with equal frequency in men and women. E – these folk are seen in the ER so they are more likely to be involved in MVA’s – possibly due to alcohol. But I don’t find these statements unreasonable.

    The mTBI group reported significantly greater general psychological distress, post-concussion symptom severity, and post-traumatic stress severity than OI (allp<0.0001) and TDC (all p<0.0001); the OI and TDC groups responded similarly on these variables. (OI is orthopedically injured) – again seems reasonable.

    The personal experience and reporting of post-concussion symptoms is likely individualized, representing the cumulative effect of multiple variables, such as genetics, mental health history, current life stress, medical problems, chronic pain, depression, personality factors, and other psychosocial and environmental factors. The extent to which damage to the structure of the brain contributes to the persistence of post-concussion symptoms remains unclear. – again seems valid.

    Prior treatment of a psychiatric condition was the strongest independent predictor for symptom reporting in boys, followed by a history of migraines. For girls, the strongest independent predictors were prior treatment of a psychiatric condition or substance abuse and attention-deficit/hyperactivity disorder. The weakest independent predictor of symptoms for both sexes was history of prior concussions. – this seems valid – its not saying that its all psychiatric but certainly a history of psychiatric issues will be exacerbated with a TBI.


  2. Agreed – there are many factors that come into play. And of course following BI, you’ve often got a “slew” of psychological issues to address. No argument there. The issue I’m taking with the discussion is the focus on the psychological over the physical, to the point of saying patients are exaggerating or over-reporting. This also raises a flag for me, as the female population is disproportionately represented in the PCS population — and women’s pain and issues are notoriously under-rated. Recent studies have shown that women in pain are left waiting longer in ER’s, and they get treatment less promptly than men.
    So, that plays a role, I believe.

    Yes, you’ve got psychological issues, but there’s so much talk in the papers about the psychological roots of PCS suffering, that the physiological gets less attention. The way it’s handled I think is backwards — look at the physical and functional changes — then look at the psychological effects — then look at how the psychology affects the physical experience (reported or otherwise). Not only does the cognitive-behavioral focus take the attention off the physical changes and organic issues which underlie the experience, but putting a psych focus on things can also exacerbate emotional lability issues — and blind everyone to the underlying physiology of things which is continuing to screw things up.

    Vision & vestibular issues are a great example. They can be so convoluted and energy-consuming, there’s nothing left for anything else. See “The Ghost in my Brain” for exhaustive detail on that. In that case, it was a male professor who was dismissed by every expert he saw, until he connected with a vision person, and he suffered for 7 years. We’ll never know what personal toll that took on his family, but I can guess. And I know from personal experience that vestibular issues will wreck my mood and composure like nothing else. When I was seeking psychotherapy help for my mood swings and irritability, I was encouraged to “explore my emotions” — the wrong thing to do. What I really needed to do, was cut out the dairy and gluten, catch up on my sleep, and really work on my physical balance. Magically, when that was handled, my mood improved 100-fold. No therapy required.

    Official studies aside, I can recount many, many instances where identifying, addressing, and resolving physiological issues related to getting clunked on the head, have done me more good than years of therapeutic forays into my “unresolved” past.


  3. Hmmm – I actually know Clark Elliot – I agree that there are often physiological issues – and the rehabilitation therapy that he used was what worked for him. Others I know have used this to some degree of success but not the same. However Clark would also agree that he was fortunate in some ways in that he was able to retain his job. Had he lost his job and family and friend he would have felt a great psychological impact from that (which is a normal reaction) – and that managing that response might have been primary. Cog Behavior Therapy is not about exploring your emotions per se – its more about recognizing that you are being self-defeating – exactly what you did on your own – changing diet, exercising etc empowered you. THe process of rehab and the process of brain injury disempowers people, they are rejected by family, friends, workplace – they experience depression and fall into serious despair. Also they WILL fail at things, the only way they can learn how to improve is to try things and learn from the mistakes – but the programs that exist don’t encourage this, don’t build resilience and so the failure is seen as a representation of a broken person. There is a line from the book ONe Hundred Names for Love about a brilliant writer who had a stroke – he described his struggle to speak as thus – ‘Just the soft catechism of a great machine falling apart’. I think that the psychological needs to go hand in hand with the physical and be recognized as a part of the rebuilding and healing process – its normal to feel that you are damaged good – but to recognize that is a feeling and not the truth. ANd if society tells you otherwise you will need to learn how to find resources to combat that.


  4. That’s very cool that you know Clark Elliot. And yes, you make some excellent points, all of which I agree with. I’ll be revisiting the research to tease out exactly what’s there. My rigor has not been up to my own standards, so it’s time to work on that. Interestingly, in the past several months, I’ve been finding myself misreading things — literally seeing different words on the paper, than what are there. And I’ve been skipping letters when I write longhand — it’s fascinating, how I’ll actually leave a space for the letter, but I’ll not write it. This never happened before. It may be related to an increase in the volume I’ve been reading and writing, or just how much I’ve been doing … and sleep disturbances.

    Anyway, I absolutely agree about the rehab & society piece of things. For all the times I’ve been hit on the head and saw pieces of my life fall apart, I never got much help putting it back together — just a lot of commands to “get my act together”. It’s no fun, having to figure it out for yourself, and had I not found a capable neuropsych, I’d probably be living a very different life than I am now.

    I got lucky.

    A lot of other people don’t — and can’t.


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