Examining the role of neuropsychology in community-based pediatric mental health care.

Numerous investigations have demonstrated a link between neuropsychological functioning and mental health. Children with a history of neurological compromise are more vulnerable to mental illness and there is a growing literature indicating that neurocognitive functioning predicts psychosocial outcomes in adulthood. However, not much is known about how neuropsychological information is utilized in community-based mental health care. Thus, we examined what neuropsychological information is available to pediatric centers and how neuropsychological functioning relates to treatment outcomes in these settings. Two content analyses were conducted to identify mental health indicators across different intake sources and these results were compared to a structured intake. Further, a series of standardized neurocognitive and neuroemotional measures were completed and these indices were correlated with treatment outcomes. Qualitative results confirmed that neuropsychological factors are often overlooked when utilizing current approaches and that observable symptoms are a primary focus of treatment. Additionally, neurocognitive deficits were associated with self-reported interpersonal difficulties and caregivers' reports of externalizing; however, only caregiver-reported externalizing challenges correlated with treatment outcomes. Importantly, neurocognitive challenges were associated with long-term treatment responses, suggesting that these factors may be an important therapeutic target. Collectively, these findings indicate a need to incorporate neuropsychological factors in pediatric mental health treatment.

Investigating cannabis use and associated symptoms among university students with and without a history of concussion.

Recently, there has been a growing interest in the use of cannabis after traumatic brain injury (TBI); however, little is known about the long-term effects of cannabis on milder injuries and post-concussive symptoms. Further, substance use often increases post-TBI and, thus, individuals who chronically use cannabis may unknowingly be exceeding safe or therapeutic doses. The current cross-sectional study explores the prevalence of cannabis use among university students with and without a history of concussion and examines the relationship between concussion and post-concussive symptoms as a function of cannabis use. Eighty-four undergraduates (n = 51 without a prior concussion; n = 33 with a prior concussion) completed a series of questionnaires, capturing their head injury history, current and past substance use, and post-concussive symptomatology. Results indicated that those with a history of concussion were more likely to use cannabis and had higher cannabis use severity scores compared to those without a previous concussion. Further, among cannabis users only, concussion severity demonstrated a significant positive association with post-concussive symptom (e.g., headaches, memory problems) severity (i.e., frequency, intensity, duration). Taken together, the long-term use of cannabis may be detrimental to individuals with a history of concussion, exacerbating, rather than mitigating, post-concussive symptoms.

Alcohol misuse and traumatic brain injury: a review of the potential roles of dopaminergic dysfunction and physiological underarousal post-injury.

Although many researchers have demonstrated an increase in alcohol use following traumatic brain injury (TBI), there is also a body of research indicating that alcohol misuse predisposes one to injury and precedes TBI. Accordingly, various mechanisms have been proposed (e.g., self-medication, dampened levels of arousal, dopaminergic dysfunction, etc.) and variable results have emerged. This paper reviews the empirical evidence, for and against, TBI as a risk factor for alcohol misuse. In particular, this paper focuses on the brain-behavior relationships involved and examines the roles of physiological underarousal and dopaminergic dysfunction in the development of alcohol misuse after injury. Alcohol misuse impedes community reintegration among TBI survivors and creates additional rehabilitative challenges. Thus, in order to inform and improve treatment outcomes among this vulnerable population, a deeper understanding of the neural mechanisms implicated is needed.

Examining the "reading the mind in the eyes test" as an assessment of subtle differences in affective theory of mind after concussion.

Objective: This research examined affective theory of mind (ToM) differences between university students with and without a history of concussion using the revised Reading the Mind in the Eyes Test (RMET). Although, previous studies have shown that affective ToM is subserved by the ventromedial prefrontal cortex - a region that is vulnerable in head injury - few have examined whether subtle deficits in affective ToM are evident after concussion. Given the RMET's sensitivity to affective deficits following moderate-to-severe traumatic brain injury, the current study examined its validity following concussion and its correlation with related ToM measures and constructs, such as empathy.Method: Seventy-seven students with and without a history of self-reported concussion completed the RMET, the Interpersonal Reactivity Index, a novel Perspective-Taking Task, and the Questionnaire of Cognitive and Affective Empathy. Indices of spelling/reading capabilities were obtained and baseline electrodermal activation was recorded as an index of arousal.Results: RMET performance did not differ between individuals with and without a prior concussion when controlling for sex and spelling/reading skills and was not correlated with other measures of affective ToM, empathy, and arousal. However, spelling/reading skills were found to be a predictor of RMET performance among both concussion and no-concussion groups.Conclusions: Together, these findings imply that the RMET is not sensitive to ToM impairments after concussion and may be related to language skills among neurotypical students.

Physiological underarousal as a mechanism of aggressive behavior in university athletes with a history of concussion.

INTRODUCTION: Research has indicated that athletes who engage in high-risk athletic activities, such as football and hockey, have riskier personalities than their low-risk and nonathlete counterparts (Ahmadi et al., 2011, Procedia Soc Behav Sci, 30 and 247-251; Zuckerman, 1983, Biological bases of sensation seeking, impulsivity, and anxiety, Lawrence Erlbaum Assoc Inc.). For instance, increased sensation-seeking and aggression are common in high-risk athletes, rendering these individuals more likely to sustain a subsequent injury, such as concussion. Elevated levels of certain personality traits, including impulsivity and aggression, have also been observed after concussion (Goswami et al., 2016, Brain Struct Funct, 221 and 1911-1925). The purpose of this study therefore was to determine whether aggressive behavior in university athletes may be accounted for, in part, by a history of concussion, rather than exclusively athletic status. METHODS: Using a quasi-experimental design, 66 university students (n = 18 nonathletes, n = 24 low-risk athletes, n = 24 high-risk athletes) with (n = 27) and without a history of concussion (n = 39) completed the Buss & Perry Aggression Questionnaire (BPAQ; Buss & Perry, , J Pers Soc Psychol, 63 and 452) and provided electrodermal activation (EDA) as an index of physiological arousal. RESULTS: It was found that decreased physiological arousal among students with a history of concussion was associated with greater endorsement of physical aggression. Moreover, athletic status did not account for this pattern of aggression, as athletes and nonathletes did not differ in terms of self-reported aggressive tendencies. CONCLUSIONS: Physiological compromise after concussive injury may act as an independent mechanism of aggressive behavior in athletes beyond factors, such as athletic status.

The relationship between concussion and alcohol consumption among university athletes.

INTRODUCTION: This study investigated concussion as a potential risk factor for increased alcohol consumption in university athletes. METHODS: Using a cross-sectional design, 41 university students (37% with a history of concussion) completed self-report measures, while electrodermal activation (EDA) was recorded for each participant to capture baseline physiological arousal. RESULTS: As expected, concussion status significantly predicted alcohol consumption over and above athletic status, b = 0.34, p = 0.034, 95% CI [0.195, 4.832], such that those with a prior concussion history engaged in greater alcohol consumption. Importantly, concussion status also significantly predicted baseline physiological arousal, b = -0.39, p = 0.014, 95% CI [-0.979, -0.120], such that those with a history of concussion exhibited lower EDA. CONCLUSIONS: Elevated alcohol consumption among athletes is a pronounced associate of concussion in sports and may be a behavioral reflection of disruption to the orbitofrontal cortex - an area implicated in inhibition.

Moral decision-making in university students with self-reported mild head injury.

Converging evidence shows that the prefrontal cortex is involved in moral decision-making. Individuals who have suffered injury to the ventromedial prefrontal cortex are more willing to endorse personal moral transgressions (e.g., make their decisions faster, and have attenuated sympathetic responses to those violations). We examined whether university students who have experienced a mild head injury (MHI), and are asymptomatic, present with a similar pattern of responding to moral dilemmas. Students reporting a history of MHI responded more quickly when making moral choices and exhibited less reticence toward the endorsement of personal moral transgressions than their non-MHI counterparts. Our results are consistent with studies involving persons with more serious, and evident, neuronal injury, and emphasize the important relationship between head injury and moral decision-making.

Physiological emotional under-arousal in individuals with mild head injury.

PRIMARY OBJECTIVES: This study examined the potential emotional sequelae following self-reported mild head injury (MHI; e.g. 'altered state of consciousness' [ASC]) in university students with a particular focus on arousal status and responsivity to experimental manipulation of arousal. RESEARCH DESIGN: A quasi-experimental design (n = 91) was used to examine arousal status (self-reported and physiological indices) and response to manipulated arousal (i.e. induced psychosocial stress/activation; reduced activation/relaxation) between persons who acknowledged prior MHI and persons with no-MHI. MAIN OUTCOME AND RESULTS: University students who self-reported MHI were physiologically under-aroused and less responsive to stressors (both laboratory and environmental) compared to their no-MHI cohort. Those with reported loss of consciousness demonstrated the most attenuated emotional arousal responses (i.e. flattened electrodermal responsivity) relative to those with only a reported ASC, followed by those with no-MHI. CONCLUSIONS: The under-arousal in traumatic brain injury has been hypothesized to be associated with ventromedial prefrontal cortex disruption. This under-arousal may be mirrored in persons who self-report experiencing subtle head trauma. Students who reported MHI may be less able to physiologically respond and/or cognitively appraise stressful experiences as compared to their no-MHI cohort; and experience subtle persistent consequences despite the subtle nature of the reported head trauma.

Mild head injury and sympathetic arousal: investigating relationships with decision-making and neuropsychological performance in university students.

SUMMARY: The purpose of this study was to examine the relationships between neuropsychological performance, physiological arousal and decision-making in university students who have or have not reported a history of mild head injury (MHI). METHODS: Forty-four students, 18 (41%) reporting a history of MHI, performed a design fluency task and the Iowa Gambling Task (IGT) while electrodermal activity (EDA) was recorded. RESULTS: General cognitive ability and overall choice outcomes did not differ between groups. However, self-reported MHI severity predicted decision-making performance such that the greater the neural indices of trauma, the more disadvantageous the choices made by participants. As expected, both groups exhibited similar base levels of autonomic arousal and physiological responses to reward and punishment outcomes; however, those reporting MHI produced significantly lower levels of EDA during the anticipatory stages of decision-making. CONCLUSIONS: Overall, these findings encourage the acceptance of head injury as being on a continuum of brain injury severity, as MHI can emulate neurophysiological and neuropsychological features of more traumatic cases and may be impacting mechanisms which sustain adaptive social decision-making.

Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke?

BACKGROUND: Dysphagia occurs in up to 50% of patients admitted to hospital with acute strokes with up to 27% remaining by seven days. Up to 8% continue to have swallowing problems six months after their stroke with 1.7% still requiring enteral feeding. Nasogastric tubes (NGT) are the most commonly used method for providing enteral nutrition in early stroke, however they are easily and frequently removed leading to inadequate nutrition, early PEG (Percutaneous Endoscopic Gastrostomy) insertion or abandoning of feeding attempts. Looped nasogastric tube feeding may improve the delivery of nutrition to such patients. METHODS: Three centre, two arm randomised controlled trial, with 50 participants in each arm comparing loop (the intervention) versus conventional nasogastric tube feeding. The primary outcome measure is proportion of intended feed delivered in the first 2 weeks. The study is designed to show a mean increase of feed delivery of 16% in the intervention group as compared with the control group, with 90% power at a 5% significance level. Secondary outcomes are treatment failures, mean volume of feed received, adverse events, cost-effectiveness, number of chest x-rays, number of nasogastric tubes and tolerability. TRIAL REGISTRATION: ISRCTN Number: ISRCTN61174381.