(PS11-A21) Changes in Postconcussive Symptoms (PCS) With PTSD Treatment: A Reconceptualization of PCS

Traumatic Brain Injuries (TBI) and Posttraumatic Stress Disorder (PTSD) have been frequently reported by Veterans who served in the wars in Iraq and Afghanistan (e.g., Hines et al., 2014; Hoge et al., 2008). While previous findings suggest that a significant portion of people will recover from mild TBI (e.g., Taylor et al., 2012; Terrio et al., 2009), a portion of people may experience a group of persistent symptoms that can present with physical, emotional, and cognitive symptoms (Kay et al., 1993). These symptoms are referred to as postconcussive symptoms (PCS).  As the name implies, conceptually these symptoms have been attributed to concussion and head injury. However, previous studies indicate that PCS may not be specific to head injury and may also be related to psychiatric concerns (Hoge et al., 2008; Porter et al., 2018, Waldron-Perrine, 2014). The current study aimed to explore how PCS changed with PTSD treatment in a sample of combat OEF/OIF/OND Veterans.

Method: The current study utilized data from 199 participants who participated in a randomized control trial comparing the impact of three empirically validated treatments for PTSD in treatment seeking combat Veterans.  Participants were randomized to one of three treatment conditions (Prolonged Exposure Therapy, Sertraline, or both).  They also completed a measure of potential TBI exposure during their deployment, and were assessed for PCS over the course of treatment.  

Results: PCS decreased over the course of treatment and no significant differences were found based on treatment arm when the full sample was examined (χ2(1, N = 198) = 1.14, p = 0.56). Additionally, there was no significant difference in PCS change between those with (n=100) and without (n=99) a history of potential TBI.  Reductions in PCS were associated with  shifts in PTSD (b = .19, p < 0.001, n = 171) and depression (b = .41, p < 0.001, n = 171).  

Conclusions: Data from this study of Veteran seeking treatment for PTSD suggest that improvements in psychiatric symptoms with PTSD treatment are associated with reductions in PCS. This prospective finding adds support to the existing literature that PCS are not specific to TBI, and indicates that clinically it is important to consider the presence of and treat any identified psychiatric symptoms and/or conditions in patients reporting persistent PCS.