PTSD and TBI co-morbidity: scope, clinical presentation and treatment options.

PRIMARY OBJECTIVE: To summarize the literature on post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) and their co-morbidity, focusing on diagnosis, clinical symptoms and treatment issues relevant to the clinician. RESEARCH DESIGN: Review of the literature. METHODS AND PROCEDURES: Pubmed searches were performed using the terms post-traumatic stress disorder, traumatic brain injury, sleep, cognitive, depression, anxiety, treatment and combinations of these terms. Those articles relevant to the objective were included. MAIN OUTCOMES AND RESULTS: This study presents pathophysiological, neuroimaging and clinical data on co-morbid PTSD and TBI. It reviews associated conditions, emphasizing the impact of cognitive and sleep problems. It summarizes the emerging literature on treatment effectiveness for co-morbid PTSD and TBI, including psychotherapy, pharmacotherapy and cognitive rehabilitation. CONCLUSIONS: Both PTSD and TBI commonly occur in the general population, both share some pathophysiological characteristics and both are associated with cognitive impairment and sleep disruption. PTSD and TBI present with a number of overlapping symptoms, which can lead to over-diagnosis or misdiagnosis. Both conditions are associated with co-morbidities important in diagnosis and treatment planning. More research is needed to elucidate what treatments are effective in PTSD and TBI co-morbidity and on factors predictive of treatment success.

Treatment change of somatic symptoms and cultural syndromes among Cambodian refugees with PTSD.

BACKGROUND: There is only one previously published study of treatment change across initial pharmacological treatment for a minority or refugee group with posttraumatic stress disorder (PTSD). That study found that certain somatic symptoms among Southeast Asian populations did not improve across treatment. This article assesses in a culturally sensitive way symptom change through time of Cambodian patients presenting for pharmacotherapy treatment of PTSD. METHODS: Fifty-six Cambodian refugees with PTSD and no previous psychiatric treatment were assessed at baseline and then at 3 and 6 months after initiating pharmacotherapy. The measures included the PTSD Checklist; the Cambodian Somatic Symptom and Syndrome Inventory (SSI) to assess culturally salient somatic symptoms and cultural syndromes; and the Short Form-12 Health Survey to assess self-perceived functioning. RESULTS: Across treatment, large effect sizes were seen on all measures (Cohen's d = 1.1-1.4). The SF-12 change score was more highly correlated to the SSI change score (r = .82) than to the PTSD change score (r = .61). Significant change only occurred from baseline to 3 months. CONCLUSIONS: Pharmacological treatment for traumatized Cambodian refugees with PTSD seems to lead to improvement not only in PTSD symptoms, but also in culturally salient somatic symptoms and cultural syndromes. Culturally sensitive assessment and treatment should ideally include the assessment of culturally salient somatic symptoms and cultural syndromes.