RESUMO
OBJECTIVE: After concussion, approximately 30% of adolescents experience symptoms that persist beyond 1 month postinjury. For some, these symptoms affect functioning, development, and quality of life. Somatization, where psychological distress contributes to physical symptoms, may contribute to persistent symptoms after concussion in some adolescents. Understanding how clinicians identify somatization in adolescents with persistent symptoms after concussion in practice is a critical next step in improving our understanding, identification, and subsequent treatment of somatization in this patient population. To address this, the investigators assessed and compared characteristics of adolescents with persistent symptoms after concussion with and without clinician-identified somatization. METHODS: Participants were adolescents (N=94) referred for persistent symptoms after concussion to a specialty youth concussion clinic between January 2016 and May 2018. A retrospective chart review extracted demographic and injury characteristics, symptoms after concussion, school attendance, premorbid experiences, mental health, and medical service use. Participants with physician-identified somatization were compared with those without physician-identified somatization on these measures. RESULTS: Adolescents with identified somatization had more severe and atypical neurological and psychiatric symptoms after concussion and more postinjury impairment in school attendance, were more likely to have a history of premorbid chronic pain or medically unexplained symptoms, and obtained more neuroimaging and health care after injury compared with those unaffected by somatization. They did not differ in mood or anxiety symptom self-reports. CONCLUSIONS: This study identified characteristic differences and similarities in adolescents with and without clinician-identified somatization after a prolonged concussion recovery. These findings have the potential to improve clinical identification of somatization in youths following a concussion and may aid in treatment among this demographic group.
Assuntos
Concussão Encefálica , Sintomas Inexplicáveis , Síndrome Pós-Concussão , Adolescente , Ansiedade , Concussão Encefálica/complicações , Concussão Encefálica/epidemiologia , Humanos , Síndrome Pós-Concussão/epidemiologia , Síndrome Pós-Concussão/etiologia , Qualidade de Vida , Estudos RetrospectivosRESUMO
Somatization may contribute to persistent symptoms after mild traumatic brain injury (mTBI). In two independently-recruited study samples, we characterized the extent to which symptoms atypical of mTBI but typical for patients suffering from somatization (e.g., gastrointestinal upset, musculoskeletal, and cardiorespiratory complaints) were present in adult patients with prolonged recovery following mTBI. The first sample was cross-sectional and consisted of mTBI patients recruited from the community who reported ongoing symptoms attributable to a previous mTBI (n = 16) along with a healthy control group (n = 15). The second sample consisted of patients with mTBI prospectively recruited from a Level 1 trauma center who had either good recovery (GOSE = 8; n = 32) or poor recovery (GOSE < 8; n = 29). In all participants, we evaluated atypical somatic symptoms using the Patient Health Questionnaire-15 and typical post-concussion symptoms with the Rivermead Post-Concussion Symptom Questionnaire. Participants with poor recovery from mTBI had significantly higher "atypical" somatic symptoms as compared to the healthy control group in Sample 1 (b = 4.308, p < 0.001) and to mTBI patients with good recovery in Sample 2 (b = 3.169, p < 0.001). As would be expected, participants with poor outcome in Sample 2 had a higher burden of typical rather than atypical symptoms [t (28) = 4.750, p < 0.001, d = 0.88]. However, participants with poor recovery still reported atypical somatic symptoms that were significantly higher (1.4 standard deviations, on average) than those with good recovery. Our results suggest that although "typical" post-concussion symptoms predominate after mTBI, a broad range of somatic symptoms also frequently accompanies mTBI, and that somatization may represent an important, modifiable factor in mTBI recovery.
RESUMO
En Jamaica, la abrumadora mayoría de los jóvenes son personas bien ajustadas social y emocionalmente. Sin embargo, el aumento vertiginoso de las agresiones y la violencia en la niñez, y la conducta delincuencial entre los jóvenes se han convertido en una gran preocupación para la sociedad y constituyen un grave problema de salud pública. A falta de investigaciones definitivas sobre las causas, las especulaciones apuntan a la frustración, los sentimientos de inadaptabilidad y la falta de autonomía de los jóvenes. El propósito de este artículo es revisar la literatura y describir la información existente relacionada con la violencia en Jamaica y evaluar la plausibilidad de las suposiciones de la población acerca de los factores relacionados con este problema. Según la literatura analizada, hay una convergencia de factores a niveles micro y macro que influyen fuertemente en el comportamiento de los niños y los jóvenes jamaicanos. En este trabajo, estos factores se operacionalizan en tres niveles: el individual, el contexto social proximal (la familia y la escuela) y el contexto social distal (i.e., las circunstancias económicas). A partir de la literatura, se concluye que el comportamiento violento de algunos jóvenes jamaicanos puede tener sus raíces en la confluencia de los problemas que abruman a las familias, los niños y los jóvenes. La exposición de los niños a la violencia, tanto en el seno familiar como en la escuela, es particularmente preocupante. Se discuten las implicaciones para las decisiones en políticas.