Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology.

OBJECTIVE: To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome. DESIGN: This consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%. SETTING: Specialist outpatient services. PARTICIPANTS: Members of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England. PRIMARY OUTCOME MEASURE: A consensus statement on the structure and process of specialist outpatient care for patients with concussion in England. RESULTS: 55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics. CONCLUSIONS: This work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway.

Is the content of confabulation positive? An experimental study.

There has been little experimental work investigating the emotional content of confabulation, despite clinical descriptions of self-serving and affectively positive biases. False memories were elicited in 10 amnesic confabulating patients, 10 healthy controls and four amnesic control patients without confabulation. Memory protocols of the interviews with these groups were presented to naïve raters who were asked to rate the emotional valence of the listed confabulations. The false memories of the confabulating patients were found to distort previous experiences in ways significantly more pleasant and self-enhancing than those of controls. It was also found paradoxically that the more depressed the patients' mood the more positive the content of their confabulations. These findings suggest that the content of confabulation is mostly positive. The results have implications for the role of emotion and motivation in confabulation, as well as for the clinical management of confabulating patients.

Self-enhancing confabulation: revisiting the motivational hypothesis.

We report a patient who developed spontaneous confabulation following surgical clipping of an anterior communicating artery aneurysm. An autobiographical memory test was used to measure the emotional valence of the patient's self-representations in true and false memories. We found that his confabulations included significantly more positive self-representations than his true memories and that the overall valence of his confabulations was more positive than that of his true memories and than that of the memories of five healthy control participants of the same age and educational attainment. It is proposed that while cognitive dysfunction may explain how confabulations are formed, emotional factors may explain which specific confabulations are constructed.