Charles J. Long

Post-Concussion Symptoms: Cognitive, Emotional, and Environmental Aspects

Two head injury patients who experienced the onset and/or exacerbation of post-concussion symptoms (i.e., headache, confusion, and memory difficulty) associated with increased environmental stress are presented. The cases provide insight into the complex interaction between neurological and psychological factors following head injury. Patients should be made aware of cognitive limitations during the recovery period so as to better determine acceptable levels of environmental stress. The development or exacerbation of post-concussion symptoms during convalescence signals the physician that a discrepancy exists between the patients cognitive capacities and environmental demands. Timely intervention to modify environmental stress would help alleviate problems with post-concussion symptoms.

Decision strategies in neuropsychology II: determination of age effects on neuropsychological performance.

The relationship of age to neuropsychological test performance was explored on the subtests comprising the Halstead-Reitan Battery and allied tests. Performance of 192 pseudo-neurologic control patients across 10-year age intervals from 16 to 65 was analyzed. The findings indicate a strong age-performance effect on spatial and more complex integrative tests with peak performance between 25 to 35 years of age and a decline thereafter. A lack of significant decline was noted on sensory, motor, and language tasks. The findings reveal that there is a curvilinear change in performance as a function of age and were discussed with regard to the obvious need to modify decision strategies to account for the age of the patient.

The Relationship Between Neuropsychological Functioning and Psychopathology in Temporal Lobe Epileptic Patients

Summary: With the use of Goldbergs method of Minnesota Multiphasic Personality Inventory (MMPI) analysis, evidence has been recently provided of a positive relationship between psychopathology and deficits in neuropsychological functioning in epileptic patients. The present study attempted to replicate this finding using more precise and appropriate criteria for grouping patients according to severity of neuropsychological impairment. Application of Goldbergs MMPI Rules to 34 temporal lobe epileptic patients grouped according to their neuropsychological status (nonimpaired or impaired) failed to support these findings. Possible reasons for the discrepant results, including differing methodologies and seizure patient characteristics across studies, are discussed.

Improving diagnostic strategies for pain patients.

Any pain experience results from the interaction of biological and functional (namely, psychological and environmental) factors. In some cases functional factors may be primarily responsible for exacerbating and maintaining pain, therefore, the physician should be attentive to a variety of signs that may indicate a significant nonorganic component to the patients pain. Problems in case management commonly arise when the organic signature is blurred, for pain patients are notoriously resistant to any suggestion that their pain is not purely organic in origin. Clinical experience has shown that the diagnosis and treatment of pain patients can be greatly facilitated by educating the patient about the complex nature of pain and by integrating the assessment of functional factors into the overall diagnostic work-up.

Reaction time and diazepam plasma concentration in subjects with normal gastric pH

The present study investigated the relationship of reaction time with the plasma concentration of four different formulations of diazepam (liquid, original, new, and generic). On four separate days, over a 4-month period, subjects with normal gastric pH (N=7) were administered each of the diazepam formulations. Blood samples were obtained prior to each dose and at subsequent intervals. Likewise, reaction times were evaluated prior to dosing and then at ten different intervals post-dosing. As hypothesized, reaction time performance was associated with plasma diazepam concentration, regardless of formulation type. This suggests that reaction time is a sensitive measure of cerebral functioning for individuals who are treated with diazepam. In addition to providing a measure of drug effects on cognitive functioning, the results of this study have implications concerning possible hazards of operating machinery or driving motor vehicles for individuals being treated with diazepam.