Introduction
The article seeks to synthesize the prevalence and accuracy of the diagnostic methods as well as the effectiveness of the available treatment methods for mild traumatic brain injury (mTBI) as well as posttraumatic stress disorder (PTSD). According to the authors, the available literature does not focus on the possible co-occurrence of the two conditions (Carlson et al., 2011). There is a need to review the appropriate management in case a patient present with the two conditions given that war veterans from the Iraq and Afghanistan war are returning home exhibiting symptoms of the two conditions.
The authors report that traumatic brain injury is common among soldiers as a result of falls and blasts. Carlson et al. (2011) states that researchers have argued that TBI and PTSD are mutually exclusive. Recent evidence has however indicated that persons with TBI may also develop PTSD whether from the same event or a different event altogether.
The study seeks to find out the prevalence of TBI/PTSD and the variations in the prevalence based on the severity of TBI, as well as other related variables. The authors also seek to identify the accuracy of the methods that individually diagnose the two disorders separately and how effective the methods are when diagnosis case of concurrent cases (Carlson et al., 2011). Finally, the researchers seek to find out whether there are treatment methods for managing mTBI/PTSD and whether the methods have limitations.
Procedures
The authors searched databases to identify articles to be included in the review from PubMed, PsychINFO, REHABDATA, as well as Cochrane databases (Carlson et al., 2011). The search involved the use of terms that are related to TBI, as well as other variants of brain injury. Terms related to PTSD were also used and alongside other options that are related to combat disorders and their variants. From the process, the authors were able to identify studies including both TBI, as well as PTSD. To be more specific, the authors limited the search to articles published in English for the period beginning from January 1980 to June 2009. The authors also sort expert recommendations on which studies to include in the review as well as looking the references from the selected articles.
The inclusion criteria for the articles involved operationalization traumatic brain injury to force to the head that leads to a history of confusion, disorientation as well as loss of consciousness. As a condition, the studies were only included in the review if the authors had assessed their subjects for TBI or had diagnosed TBI from the patient’s history. To examine any existing variations in the prevalence of PTSD based on TBI severity, the authors included studies that examined patients with all levels of TBI (Carlson et al., 2011). The authors operationalized PTSD to be in line with the symptoms described in the Diagnostic and Statistical Manual of Mental Disorders (DSM) III or IV.
The authors exclude case reports as well as articles whose total number of subjects included more than 10% of persons who were below eighteen years of age. Other studies that did not present results in a way that could address the questions of interest were excluded from the systematic review (Carlson et al., 2011).
During the synthesis and data extraction process, the authors screened the articles so as to figure out which article was appropriate for answering which research questions. Once classified as the research questions the studies were entirely reviewed to establish if they met the other inclusion criteria. The authors then extracted the data from the selected studies and recorded it on standardized forms that included several parameters. The record included the study participants, the number of TBI/PTSD cases, the study setting, the target population as well as other demographics. The events leading to TBI, as well as the level of TBI, were also identified.
The authors compared the study methods as well as the results obtained allowing them to draw conclusions. The findings of the review were summarized in a manner that mirrored the key variables. The authors also rated the quality of the studies based on the descriptiveness as well as the level of heterogeneity.
Findings
The authors used all the 34 studies that had been identified in addressing the first research question. The frequency of TBI/PTSD was between 0% to 70% with the majority of the studies having a frequency of 20% and below. Studies that had a rate of 50% and above were also characterized by an unrepresentative sample. According to the authors, participants with TBI who were followed over time did not show any frequency in PTSD. The authors also indicate there were no notable differences in PTSD among the military and non-military participants.
According to Carlson et al. (2011), the study did not find any study that examined the assessment of PTSD among the individuals with mTBI or vice versa. Thus, the studies did not meet the inclusion criteria. To achieve the objective, the authors identified a single study whose objective was to compare the accuracy of PTSD diagnostic measures. The measures that were compared included the use of self-report questionnaires such as the Impact of Events Scale and the Post-Traumatic Diagnostic Scale. Other methods that were evaluated included the Clinician Administered PTSD Scale as well as the clinical judgment of the attending physician. All the methods were found to be appropriate for the diagnosis of PTSD with no significant discrepancies in the results obtained.
There was no study focusing on the management of PTSD or mTBI among participants with mTBI/PTSD. The author found a randomized control trial whose objective was to examine how effective cognitive behavior therapy (CBT) was in treating acute PTSD in patients with a history of mTBI (Carlson et al., 2011). From the study, it was noted that CBT was effective in the reduction of PTSD symptoms as well as delaying the onset of PTSD among patients with mTBI.
Discussion
According to the authors, there was minimal evidence on the frequency of TBI/PTSD based o severity of TBI levels. The situation was coupled by a lack of studies that addressed the effectiveness of mTBI/PTSD management. As such, the authors indicate that the area warrants further research given the increasing incidence of mTBI/PTSD among soldier returning from war. The authors also report that there is a possibility of the screening instruments resulting in an overestimation of the results (Carlson et al., 2011). The findings also indicate that PTSD is common among patients with TBI history.
Given that a clinician’s judgment was also important in the diagnosis of mTBI/PTSD it is, paramount that the clinicians understand co-occurring PTSD. As such the authors indicate that there is a need for comprehensive education on how to diagnose the co-occurring PTSD. There are no enough studies that outline the prevalence, assessment, as well as management of mTBI/PTSD among soldiers. The few available studies had inadequate samples sizes as well as included a highly selective population of participants. Assessment methods for the studies varied widely and as such generalizability of the studies was limited. However, the authors acknowledge the fact that to conduct a systematic review of a similar nature has multiple limitations given the need to address the research questions adequately.
According to the authors, existing studies have preliminary information that can be used as a basis for further research. Areas of further research include developing a consensus on how to measure mTBI as well as PTSD (Carlson et al., 2011). The prevalence, as well as the outcomes of TBI/PTSD among soldiers, should be evaluated. It is of importance that researchers conduct studies reflecting on the accuracy as well as the effectiveness of the available therapeutic methods. The authors also recommend that the research should extend to include assessment methods and their application in the diagnosis of mTBI. Further research should also focus on the examination of the efficacy as well as the clinical management of mTBI/PTSD (Carlson et al., 2011). The authors also recommend the evaluation of the evidence-based management of PTSD.
Conclusion
Frequencies of mTBI/PTSD vary widely in the studies reviewed given the differences in samples sizes, research designs as well as the objectives. The authors indicate some areas had not been adequately considered such as the accuracy of the diagnostic methods applied in the co-occurrence of PTSD and mTBI. The efficacy of the available therapy for mTBI/PTSD has not been determined. Consensus is required over the appropriate tools to be applied in the diagnosis of mTBI, as well as PTSD. Given these deficiencies, there is a need to conduct adequate research that will help fill the existing gaps in knowledge of the matters related to the co-occurrence of mTBI, as well as PTSD.
Reference
Carlson, K., Kehle, S., Meis, L., Greer, N., MacDonald, R., Rutks, I.,…Wilt, T. (2011). Prevalence, assessment, and treatment of mild traumatic brain injury and posttraumatic stress disorder: A systematic review of the evidence. Journal of Head Trauma Rehabilitation, 26(2), 103-115.