Kristi Erdal

Brain damage or compensation neurosis? The controversial post-concussion syndrome

Abstract Neuropsychological evaluations were performed on 55 consecutive patients with persisting post-concussion syndrome (PCS). All were in litigation or were pursuing/receiving financial compensation for their injuries. No PCS patients who were not in litigation or compensated were referred over the 2-year span of the study. Many patients had deficits on neuropsychological testing. However, 15% of the patients were shown to be unconsciously or consciously motivated to do poorly on the Portland Digit Recognition Test (PDRT) and 33% fell below the cut-offs suggesting poor motivation reported by previous investigators. Only 28% of the PCS patients performed at or above the levels of patients with documented brain damage, established by previous investigators. When an additional measure of cooperation was considered (the Dot Counting Test), 48% of all patients had questionable motivation during testing. The average MMPI-2 profile of the entire PCS group suggested the presence of somatization and functional...

Psychological impact of illness downturns: a comparison of new and chronic conditions.

Older adults (N = 166) who had chronic arthritis, a chronic vision problem, new arthritis symptoms, or a new vision problem were compared with older adult controls on psychological distress and well-being. The psychological impact of new versus chronic illness stressors, and stressors associated with arthritis versus vision loss, were examined. The chronic arthritis group had the greatest psychological distress, the least well-being and the greatest self-reported pain. Results supported an additivity theory approach to chronic illness and not an anticipatory coping approach. Differences in level of pain accounted in part for elevations in distress but did not explain differences between groups in psychological well-being. Positive affect was found to be the indicator of well-being that best differentiated groups.

Depression and Anxiety in Persons with Parkinson's Disease With and Without “On–Off” Phenomena

Abstract“On–off” phenomena in Parkinsons disease (PD) are unpredictable motor fluctuations associated with long-term levodopa use. Mood fluctuations have been found to coincide with the motor fluctuations in that depression and anxiety increase while the person with PD is in the “off” state. What has been relatively unexplored is whether those persons with PD who have “on–off” phenomena differ psychologically in fundamental ways from those who do not have “on–off” phenomena. In the present study, depression and anxiety symptoms were assessed in 36 persons with PD (n = 14 with “on–off” phenomena, n = 22 without “on–off” phenomena). All those with “on–off” phenomena were assessed in their “on” state. Those persons with PD with “on–off” phenomena had significantly higher levels of anxiety than those without “on–off” phenomena. However, both groups, regardless of “on–off” status, were mildly depressed. Neurobiological interpretations of the results implicate the locus coeruleus in the pathogenesis of both “on–off” phenomena and anxiety, whereas psychological interpretations of the results involve the issues of learned helplessness and control over health symptoms in PD.

Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway

BACKGROUND Internationally, depression is a common psychological disorder whose treatment depends upon its identification by treating professionals as well as patient utilization of mental health care systems; the latter often being hampered by cultural differences between patients and health professionals. METHOD The current study used vignettes of depressed patients which varied the culture and/or social circumstances of the patient to assess whether these variables influenced the conceptualization of depression and its treatment. Participants (N=722) included mental health professionals, lay people, immigrants, and refugees in Norway. RESULTS We found that immigrants and refugees, particularly those of non-western origin, endorsed different types of depression treatments from native Norwegians and mental health professionals, and judged who deserved treatment and who was overreacting based on the patients culture and social circumstances, while native Norwegians did not. LIMITATIONS While widely used cross-culturally, vignette methodology is limited in its generalizability to real clinical situations. Acculturation was not evaluated, which may have influenced the results. CONCLUSIONS Findings support the integration of cultural competency ideals not only into treatment, but also into public health promotions of mental health services for lay people.

The relationship between the Wechsler Memory Scale—Revised (WMS-R) Attention index and putative measures of Attention

Although the Wechsler Memory Scale—Revised (WMS-R; Wechsler, 1987) is one of the more frequently used measures of memory and attention, its Attention/Concentration Index (ACI) has been minimally researched. If the ACI is to be used as a measure of “attention,” the need exists to determine if it is related to other measures theoretically argued to be sensitive to attention deficits. The present study evaluated the relationship between the WMS-R ACI and other putative measures of attention by comparing individuals labeled as Attention Impaired [ACI at least 15 points < General Memory Index (GMI)] versus those labeled as Memory Impaired (GMI at least 15 points < ACI). Contrary to expectations, the Attention Impaired group scored equal to the Memory Impaired group on all measures theorized to be sensitive to attention deficits (Trails A and B time, Trails B errors, Rey AVLT interference list), except for statistically weaker performance on Trails A errors. In contrast but as expected, the Memory Impaired group scored statistically worse on all memory tests (Rey AVLT, all TPT variables). The groups also did not differ on tests argued not to be differentially affected by either attention or memory (WAIS-R FIQ, Category Test). It is concluded that the WMS-R Attention Index is not related to deficits on other measures sensitive to attention, further emphasizing the need to identify more clearly specific attention constructs.

Diagnostic terminology, athlete status, and history of concussion affect return to play expectations and anticipated symptoms following mild traumatic brain injury

ABSTRACT “Mild traumatic brain injury” (mTBI) and “concussion” are terms often used interchangeably. However, “mTBI” is frequently seen as representing a broader injury that encompasses the construct of “concussion,” which often conveys transience or decreased severity. The present study examined the influence of varying diagnostic terminology on acute injury expectations in an undergraduate population (N = 105). Participants were presented with an mTBI vignette and were randomly assigned to one of two conditions in which the term “mTBI” or “concussion” was used to describe the injury. There were no significant differences between the two conditions on anxiety, symptomatology, timeline, or consequence scales. However, participants in the “mTBI” group allocated more days to return to play than participants in the “concussion” group, suggesting that terminology has an effect on perceptions of the severity of the injury. Varsity athletes allocated fewer days to return to play than nonathletes. Individuals with a history of concussion, both athletes and nonathletes, indicated fewer days to return to play, but greater symptomatology than individuals with no history of concussion. Clinicians should consider the influence of diagnostic terminology, athletic background, and history of concussion on perceptions of the severity of an injury because expectations can influence injury outcomes and compliance in a recovery process.