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The Postconcussional Syndrome: Social Antecedents and Psychological Sequelae

Published online by Cambridge University Press:  02 January 2018

George Fenton
Affiliation:
Department of Psychiatry, Ninewells Hospital Medical School, Dundee DD1 9SN
Roy McClelland*
Affiliation:
Department of Mental Health, Whitla Medical Building, Belfast City Hospital, 97 Lisburn Road, Belfast BT9 7BL
Anne Montgomery
Affiliation:
Holywell Hospital, 60 Steeple Road, Antrim BT41 2RJ
Geraldine MacFlynn
Affiliation:
The Mater Hospital, 47–51 Crumlin Road, Belfast BT14 6AR
*
Correspondence

Abstract

The study consisted of a prospective investigation of 45 consecutively admitted patients who had sustained a mild head injury. In all cases the duration of post-traumatic amnesia was less than 24 hours. Head injury patients had an average of three adverse life events in the year preceding injury compared with 1.5 for controls. Using the PSE, 39% of the group were diagnosed psychiatric cases at six weeks after the injury. For cases the mean level of chronic social difficulties (3.3) was four times that for non-cases (0.8). Six months after injury, 28% of the head injury group had three or more symptoms. These chronic cases were on average ten years older than those whose symptoms had remitted. Chronic cases had, on average, three social difficulties, twice as many as found among those whose symptoms had remitted. The emergence and persistence of the postconcussional syndrome are associated with social adversity before the accident. While young men are most at risk of minor head injury, older women are most at risk of chronic sequelae.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

Barth, J. T., Alves, W. M., Ryan, T. V., et al (1989) Mild head injury in sports: neuropsychological sequelae and recovery of function. In Mild Head Injury (eds Levin, H. S., Elsenberg, H. M. & Benton, A. L.). Oxford: Oxford University Press.Google Scholar
British Medical Journal (1961) Accident neurosis. British Medical Journal, i, 10181019.Google Scholar
Brooks, N. (1984) Closed Head Injury, Psychological, Social and Family Consequences. Oxford: Oxford University Press.Google Scholar
Brown, G. W. & Davidson, S. (1978) Social class, psychiatric disorder, and accidents to children. Lancet, i, 378381.CrossRefGoogle Scholar
Brown, G. W. & Harris, T. O. (1978) Social Origins of Depression. London: Tavistock.Google Scholar
Cairns, E., Wilson, R., McClelland, R., et al (1990) Improving the validity of the GHQ30 by rescoring for chronicity: a failure to replicate. Journal of Clinical Psychology, 45, 793798.3.0.CO;2-U>CrossRefGoogle Scholar
Casson, I. R., Seigel, O., Campbell, E. A., et al (1984) Brain damage in modern boxers. Journal of the American Medical Association, 251, 26632667.CrossRefGoogle ScholarPubMed
Cartlidge, N. E. F. & Shaw, D. A. (1981) Head Injury. London: Saunders.Google Scholar
Greenwood, M. & Woods, H. M. (1919) Preliminary Report on Special Tests. Sacramento, California: Dept of Motor Vehicles.Google Scholar
Gronwall, D. & Wrightson, P. (1974) Delayed recovery of intellectual function after minor head injury. Lancet, ii, 605609.Google Scholar
Gronwall, D. & Wrightson, P. (1975) Cummulative effect of concussion. Lancet, ii, 995997.Google Scholar
Henderson, S., Byrne, D. G. & Duncan Jones, P. (1981) Neuroses and the Social Environment. London: Academic Press.Google Scholar
Katz, M. M. & Lyerly, S. B. (1963) Methods for assessing adjustment and social behaviour in the community, 1. Rationale, descriptions, discriminative validity and scale development. Psychological Reports, 13, 503535.CrossRefGoogle Scholar
Levin, H. S., Mattis, S., Raff, R. M., et al (1987) Neuro–behavioural outcome following minor head injury: a three centre study. Journal of Neurosurgery, 66, 234243.CrossRefGoogle Scholar
Lidvall, H. F., Linderoth, B. & Norlin, B. (1974) Causes of the post–concussional syndrome. Acta Neurologica Scandinavica (suppl. 56), 1144.Google Scholar
Lishman, W. A. (1988) Physiogenesis and psychogenesis in the post–concussional syndrome. British Journal of Psychiatry, 153, 460469.Google Scholar
MacFlynn, G., Montgomery, E. A., Fenton, G. W., et al (1984) Measurement of reaction time following minor head injury. Journal of Neurology, Neurosurgery and Psychiatry, 47, 13261331.Google Scholar
Millar, H. C. (1961) Accident neurosis. British Medical Journal, i, 919925, 992–998.CrossRefGoogle Scholar
Montgomery, A., Fenton, G. W. & McClelland, R. J. (1984) Delayed brainstem conduction time in post–concussional syndrome. Lancet, i, 1011.Google Scholar
Montgomery, A., Fenton, G. W. & McClelland, R. J., et al (1991) The psychobiology of minor head injury. Psychological Medicine, 21, 375384.Google Scholar
Rimel, R. W., Giordani, B., Barth, J. T., et al (1981) Disability caused by minor head injury. Neurosurgery, 9, 221228.Google ScholarPubMed
Russell, W. R. (1974) Recovery after minor head injury. Lancet, ii, 1315.Google Scholar
Rutherford, W. H., Merrett, J. D. & McDonald, J. R. (1977) Sequelae of concussion caused by minor head injuries. Lancet, i, 14.Google Scholar
Rutherford, W. H., Merrett, J. D. & McDonald, J. R. (1978) Symptoms at one year following concussion from minor head injury. Injury, 10, 225230.Google Scholar
Selzer, M., Rogers, J. & Kern, S. (1968) Fatal accidents: the role of psychopathology, social stress and acute disturbance. American Journal of Psychiatry, 124, 10281036.CrossRefGoogle Scholar
Taylor, A. R. & Bell, T. K. (1966) Slowing of cerebral circulation after concussional head injury. Lancet, ii, 178180.Google Scholar
Watson, M. R., Fenton, G. W., McClelland, R. J., et al (1993) The post–concussional state revisited. British Journal of Psychiatry, (in press).Google Scholar
Whitlock, F. A., Stroll, J. R. & Rekhdahal, R. J. (1977) Psychiatric epidemiology, its uses and limitations. Australian and New Zealand Journal of Psychiatry, 11, 127132.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Wing, J. K., & Sturt, E. (1978) The PSE–ID-CATEGO System: A Supplementary Manual (Mimeo). London: Institute of Psychiatry.Google Scholar
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