Marie My Lien Rebetez

Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury

Introduction: Severe traumatic brain injury (STBI) can cause psychological stress in proxies in the long-term. This study assessed post-traumatic stress (PTS) symptoms in proxies of survivors of STBI in the short-term and investigated stress-associated factors. Methods: Prospective cross-sectional study, conducted at three Swiss trauma centres over 1 year. Patient and proxy demographics, trauma data including Glasgow Coma Scale (GCS) and management data were collected. The proxies’ PTS symptoms were assessed by applying the Impact of Event Scale–Revised (IES-R), once in the first month after the accident (median: 11 days). Results: Sixty-nine proxies were included; 52 proxies were female (77.8%). Mean IES-R sum score for intrusions was 13.38 (SD = 7.26), for avoidance 8.91 (SD = 5.94), and for hyperarousal 9.07 (SD = 6.75). Clinically significant PTS symptoms were observed in 36 proxies (52.2%); mean IES-R sum scores were significantly higher in women. IES-R sub-scale values were inversely related with GCS at the scene of the accident and on hospital admission. Conclusions: More than half of proxies had clinically significant PTS symptoms shortly after their relatives accident. More severe PTS symptoms were found in women and in proxies of patients with poorer initial GCS scores. Further research into risk groups in the short- and long-term and the long-term impact on patients of PTS syndrome in proxies is warranted.

Do emotional stimuli interfere with two distinct components of inhibition

Emotions have recently been shown to interfere with the efficacy of inhibitory control. However, understanding their impact requires taking into account that inhibition is not a unitary construct, but consists of distinct functions underlain by specific mechanisms. In this study, 88 participants performed two emotional versions of classic laboratory tasks designed to assess (1) the ability to inhibit a prepotent response (a stop-signal task using faces with different emotional expressions) and (2) the capacity to resist the effect of proactive interference (PI; a recent negative task that included emotional words). Overall results showed that emotional stimuli interfered with inhibition capacities in both tasks. Although tending in the same direction, these results suggest that different underlying mechanisms (e.g., top-down vs. bottom-up processes) or consecutive differences in emotional processing (e.g., different interactions with stimulus/task properties, processing stages or motivational aspects) are at play in these two inhibition-related functions.

The prognostic significance of the serum biomarker heart-fatty acidic binding protein in comparison with s100b in severe traumatic brain injury.

The outcome after severe traumatic brain injury (TBI) is largely unfavorable, with approximately two thirds of patients suffering from severe disabilities or dying during the first 6 months. Existing predictive models displayed only limited utility for outcome prediction in individual patients. Time courses of heart-fatty acidic binding protein (H-FABP) and their association with outcome were investigated and compared with S100b. Forty-nine consecutive patients with severe TBI (sTBI; Head component of the Abbreviated Injury Scale [HAIS] >3) with mono and multiple trauma were enrolled in this study. Enzyme-linked immunosorbent assay measured blood concentrations of H-FABP and S100b at 6, 12, 24, and 48 h after TBI. Outcome measures were conscious state at 14 days (Glasgow Coma Scale), disability (Glasgow Outcome Scale Extended; GOSE), and mortality at 3 months. Univariate logistic regression analysis and receiver operating characteristic curves analysis were carried out. Maximal H-FABP and S100b concentrations were observed at 6 h after TBI (34.4±34.0 and 0.64±0.99 ng/mL, respectively). Patients with multi-trauma had significantly higher H-FABP concentrations at 24 and 48 h (22.6±25.6 and 12.4±18.2 ng/mL, respectively), compared to patients with mono trauma (6.9±5.1 and 3.7±4.2 ng/mL, respectively). In the first 48 h, H-FABP and S100b were inversely correlated with the GOSE at 3 months; H-FABP at 48 h predicted mortality with 75% sensitivity and 93% specificity. Early blood levels of H-FABP after sTBI have prognostic significance for survival and disability.

Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

BackgroundThe relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months.MethodsForty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression.ResultsThere was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months.ConclusionsPlasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months.

Procrastination, consideration of future consequences, and episodic future thinking

Despite the intrinsic temporal nature of procrastination, little research has examined the link between this form of self-regulatory failure and the consideration of future consequences, and no study has addressed the link between procrastination and episodic future thinking. The aim of the present study was to explore these relationships. Participants were asked to project themselves into possible future events and to rate the amount of sensory-perceptual details and autonoetic consciousness associated with their representations. They were also asked to complete questionnaires that assessed procrastination, the consideration of future consequences, and negative affect. Results showed that both the consideration of future consequences and episodic future thinking were associated with procrastination, and in particular with procrastination-related decision making abilities and procrastination-related motivational dispositions, respectively.

Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury.

ABSTRACT Objective: The objective was to investigate disability and health-related quality-of-life (HRQoL) 3, 6 and 12 months after traumatic brain injury (TBI) in non-geriatric (≤ 65 years) and geriatric patients (> 65 years). Methods: Patients ≥ 16 years who sustained a severe TBI (Abbreviated Injury Scale of the head region > 3) were included in this prospective, multi-centre study. Outcome measures were Glasgow Outcome Scale Extended (GOSE; disability), SF-12 (HRQoL). Mixed linear model analyses were performed. Results: Three hundred and fifty-one patients (median age = 50 years; interquartile range (IQR) = 27–67) were included; 73.2% were male and 27.6% were geriatric patients. Median GOSE at 3, 6 and 12 months was 5 (IQR = 3–7), 6 (IQR = 4–8) and 7 (IQR = 5–8); this increase (slopetime = 0.22, p < 0.0001) was age dependent (slopeage*time = –0.06, p = 0.003). Median SF-12 physical component scale score at 3, 6 and 12 months was 42.1 (IQR = 33.6–50.7), 46.6 (IQR = 37.4–53.9) and 50.4 (IQR = 39.2–55.1); this increase (slopetime = 1.52, p < 0.0001) was not age dependent (slopeage*time = –0.30, p = 0.083). SF-12 mental component scale scores were unchanged. Conclusions: Disability decreased and HRQoL improved after TBI between 3–12 months. In geriatric patients this improvement was relevant for HRQoL only.

Association between impulsivity, emotional/behavioural hyperactivation and functional outcome one year after severe traumatic brain injury

Abstract Objective: To examine impulsivity changes after a severe traumatic brain injury (TBI) and to explore the relationships between impulsivity dimensions (urgency, lack of premeditation, lack of perseverance, sensation seeking), emotional/behavioural hyperactivation and 12-month outcome. Methods: Measures of emotional/behavioural hyperactivation and functional outcome were administered to 60 patients with severe TBI 12 months after the trauma. A scale designed to assess impulsivity changes after TBI was completed by the patients’ significant others at the same time. Results: Scores on urgency and lack of perseverance were higher after the trauma, whereas the score on sensation seeking was lower and the score on lack of premeditation remained stable. Urgency was the only dimension of impulsivity related to both emotional/behavioural hyperactivation and functional outcome. The relationship between urgency and functional outcome was mediated by emotional/behavioural hyperactivation, suggesting that a high level of urgency results in emotional/behavioural hyperactivation, which in turn impacts functional outcome. Lack of perseverance was significantly associated with functional outcome, indicating that the higher the lack of perseverance, the lower the functional outcome. Conclusion: The results contribute to a better understanding of the 12-month outcome in patients with severe TBI. They also open interesting perspectives on management strategies for implementing targeted psychological interventions to decrease impulsive manifestations.

Procrastination as a Self-Regulation Failure: The Role of Impulsivity and Intrusive Thoughts:

Procrastination has been described as the quintessence of self-regulatory failure. This study examines the relationships between this self-regulatory failure and other manifestations of self-regulation problems, namely impulsivity and intrusive thoughts. One hundred and forty-one participants completed questionnaires assessing procrastination, impulsivity (in particular, the urgency and lack of perseverance dimensions), and intrusive thoughts (i.e., rumination and daydreaming). Main results show that urgency mediated the association between rumination and procrastination, whereas rumination did not mediate the relation between urgency and procrastination. Lack of perseverance mediated the association between daydreaming and procrastination, and daydreaming mediated the relation between lack of perseverance and procrastination. This study highlights the role of impulsivity and intrusive thoughts in procrastination, specifies the links between these self-regulation problems, and provides insights into their (potential) underlying mechanisms. It also opens interesting prospects for management strategies for implementing targeted psychological interventions to reduce impulsive manifestations and/or thought control difficulties accompanying procrastination.

A French version of the Balanced Time Perspective Scale: Factor structure and relation to cognitive reappraisal.

A frequent and equal tendency to think positively about one’s past and future has been conceptualised as a balanced time perspective (TP). Such a dispositional temporal orientation has been associated with higher life satisfaction and happiness. The aim of the present study was to develop and to validate a French version of the Balanced Time Perspective Scale (BTPS; Webster, 2011), which has been specifically designed to assess the combined use of positive future and past mental representations as resources for the self. Data were collected from an online survey in a sample of 622 French-speaking individuals from the general population. Results indicated that the French version of the BTPS replicated the 2-factor structure of the original questionnaire, and showed excellent internal consistency. External validity was supported by specific relationships with measures of TP and positive affect. In addition, a high propensity to project oneself positively both in the future and the past was associated with greater use of cognitive reappraisal. La tendance fréquente et soutenue à avoir des pensées positives au sujet de son passé et de son avenir a été conceptualisée en la notion de perspective de temps équilibrée. Une telle perspective temporelle a été associée à une plus grande satisfaction à l’égard de la vie ainsi qu’à un plus grand bonheur. Le but de la présente étude était d’établir et de valider une version française de la Balanced Time Perspective Scale (BTPS; Webster, 2011), qui a été conçue spécifiquement pour évaluer l’usage combiné des représentations mentales futures et passées positives en tant que ressources pour soi. Des données ont été amassées au moyen d’un questionnaire en ligne auprès d’un échantillon de 622 francophones dans la population en général. Les résultats ont révélé que la version française de la BTPS répliquait la structure à 2 facteurs du questionnaire original et qu’elle présentait une excellente consistance interne. Sa validité externe a été confirmée par des relations précises avec des mesures de la perspective de temps et d’affects positifs. De plus, une forte propension à se projeter positivement à la fois dans l’avenir et dans le passé a été associée à une plus grande utilisation de la réévaluation cognitive.