Pain Related Functional Limitations of Persons Injured in Car Accidents

Background: In medical psychology, the Brief Pain Inventory (BPI) allows for a separate assessment of pain intensity (scales of worst, least, and average pain) and of daily functional limitations due to pain (impairments of mood, ability to walk, work, interpersonal relations, sleep, and enjoyment of life). The present study evaluates the convergent validity of BPI’s measure of such functional limitations by calculating its correlations to other relevant clinical measures of psychological impairments caused by motor vehicle accidents (MVAs). Method: De-identified archival data were available on 50 persons injured in MVAs (age 20 to 86 years, mean=42.1 years, SD=16.4; 23 males, 27 females). Their MVA occurred 11 to 280 weeks prior to psychological testing with the BPI (average time lapse 73.3 weeks, SD=53.8). All patients were still experiencing active post-MVA symptoms requiring medical attention and therapy. With respect to convergent validity, we examined Pearson correlations of the BPI to the Insomnia Severity Index (ISI), Rivermead Post-Concussion Symptoms Scale, Subjective Neuropsychological Symptoms Scale (SNPSS), and to measures of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire). Results: Functional interference of pain with daily activities (sum of BPI Items 9B to 9G) correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.39), post-MVA subjective neuropsychological symptoms (r=0.45), insomnia scores (r=0.41), and ratings of depression (r=0.52), anger (r=0.46), and anxiety (r=0.44). When the sum of BPI ratings of worst, least, and average pain was added to the functional interference/limitations score, then this sum of 9 BPI items correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.36), post-MVA subjective neuropsychological symptoms (r=0.46), insomnia scores (r=0.37), and ratings of depression (r=0.53), anger (r=0.50), and anxiety (r=0.40). Discussion and Conclusion: The results lend support to convergent validity of the BPI when applied to persons injured in vehicular accidents.

A-66 Neuropsychological Sequalae of SARS-CoV-2

Objective The purpose of this systematic review is to identify neuropsychological sequelae following infection of SARS-CoV-2. Data Selection A systematic search of the literature was conducted in 2021 using the keywords: neuropsychological symptoms, neuropsychological sequelae, neuropsychological manifestations, SARS-CoV-2, COVID-19, and coronavirus. The search conducted included a total of 6 databases: PsychNet, ProQuest, Taylor & Francis Online, EBSCOhost, Google Scholar, and PubMed Central. A total number of 25 articles were considered, and 8 of those articles were retained. Inclusion criteria consisted of peer-reviewed articles published in English between the years 2020 and 2021. Exclusion criteria consisted of articles not published in English and those that did not examine the neuropsychological symptoms following COVID-19 infection. Data Synthesis Literature examined reported that clinical observations of severe cases of COVID-19 infection were associated with the presence of neuropsychological symptoms. Post-infection of SARS-CoV-2, the following symptoms have been noted: severe executive dysfunction, fluctuations in attention and concentration, and instances of disorientation and confusion. Although etiological hypotheses have been made, there is still no consensus or treatment for the neuropsychological sequelae of COVID-19. Studies also reported that a significant risk factor for these individuals was the presence of premorbid psychological/psychiatric illnesses. Conclusions Patients who recover from severe COVID-19 can experience a multitude of neuropsychological manifestations. In some cases, these effects have been reported to be long-standing. Due to limited understanding regarding the nature and mechanism of action of SARS-CoV-2, it is difficult to pinpoint the cause, duration, treatment, and prognosis of neuropsychological symptoms of post-recovery patients.

Clinical Profile of US Combat Veterans with PTSD on M-FAST Items

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) is a widely used but controversial instrument promulgated to measure malingering. Its use is encouraged by publications which are methodologically flawed such as the recent meta-analysis by Detullio et al. (2019). In this study, we examine which of M-FAST’s 25 items are most frequently endorsed by veterans with posttraumatic stress disorder (PTSD). Method: Using tabular data published by Wolf’s team in 2020, we identified from a clinical perspective, the 7 M-FAST items endorsed by the highest proportions of 121 US combat veterans with a probable current diagnosis of PTSD. Since the M-FAST diagnostic cutoff is 6 or more points and each endorsed item counts as one point, the 7 most frequently endorsed M-FAST items provide a clinical profile, via their content, as to which items are most frequently involved in misdiagnosing veterans as malingerers. Results and Discussion: Item 2 (“feeling depressed most of the time”) was endorsed by 67.8%, Item 23 (“feeling that I don’t really matter”) by 56.2%, Item 20 (formication) by 28.9%, and Item 17 (phantosmia, i.e., “false sensation of an odor”) by 24.0%. Formication and phantosmia are legitimate neuropsychological symptoms that may occur with whiplash injuries and head trauma or exposure to toxic chemicals in combat. Item 21 (“at times hearing music coming from nowhere”) endorsed by 22.3% may describe spontaneous intrapsychic activity of musically inclined persons. Item 14 (“Sometimes it seems as if someone controls my symptoms, turning them on and off”) endorsed by 20.7% may reflect the unpredictable fluctuation of frequency and severity of PTSD symptoms. Item 1 (“restlessness while seated”) endorsed by 19.8% is scored in the M-FAST as a discrepancy between the patient reporting that he “often” feels restless, and the examiner’s observation that no such nonverbal behavior during the brief M-FAST interview was noted. Restlessness is a post-concussive symptom that is not necessarily always present, such as during the M-FAST interview. Conclusions: All 7 most frequently endorsed items by combat veterans are neither exclusive to malingerers nor pathognomonic of malingering. They form a pattern of legitimate medical symptoms fallaciously scored and interpreted in the M-FAST’s system as indicators of malingering.

Case Report in the Brazilian Context: Cognitive and Behavioral Changes Following an Electric Injury

Electrical injury (EI) is the sequel of an electrical shock. Physical sequelae are most common, but also other symptoms can happen, such as neurological symptoms, psychiatric alteration, and cognitive decline. The repercussion of EI can happen whether or not the head is a point of contact with the electrical current. There are no official diagnostic criteria for cognitive repercussions of EI, which may lead to incorrect diagnostics and confusion with other most frequent causes of dementia, such as frontotemporal dementia, pseudodementia, or dementias for reversible causes. In this case report, we described a right-handed man, aged 56 years old, referred to our service due to behavioral changes and cognitive alterations related to electric shock. The psychiatric team has monitored him, but cognitive deficits have raised doubts about the presence of dementia syndrome. The neuropsychological evaluation revealed severe deficits and loss of functionality, which filled the criteria for major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). Adding these findings to the patient's history and after a detailed investigation of other causes of dementia, we concluded that this is a possible case of EI with strong neuropsychological symptoms. This case report should help clinicians to recognize this condition and its features. We aimed to share the importance of recognizing the neuropsychological and psychiatric features of EI, mainly in the Brazilian context.

Clinical Correlations of Posttraumatic Nightmares in Survivors of Motor Vehicle Accidents

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs). Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy. Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety. Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

Serum Dopamine Level in Acute Murine Toxoplasmosis

Toxoplasmosis is a globally parasitic zoonotic disease transmitted by Toxoplasma gondii protozoa. This infection in its chronic form can cause a change in its host's specific behavior and is also associated with developing neuropsychological symptoms in humans. Changes in neurotransmitters' levels, especially dopamine, have been identified as a behavior change factor in the infected host. This study aimed to evaluate serum dopamine levels in acute murine toxoplasmosis. In this study, 50 mice infected with Toxoplasma were studied in 5 separate groups, and ten healthy mice were considered a control group. For five consecutive days after parasite injection, blood sampling and serum isolation were performed daily from one of the groups. Serum dopamine levels were measured by HPLC method. Statistical studies showed that serum dopamine on the first to the fourth day after parasite inoculation was the same as the control group, but the fifth day began to increase. The present study results indicate that dopamine production in mice infected with Toxoplasma gondii increases from day five after infection. This result suggests that in acute toxoplasmosis, dopamine production is low, and the trend of chronic disease increases dopamine production.

Validation of the PTSD Checklist for DSM-5 (PCL-5) on Patients Injured in Car Accidents

Background: The PTSD Checklist for DSM-5 (PCL-5), is presently the most widely used psychological measure of PTSD along the criteria of DSM-5. We examined the criterion validity of PCL-5 separately for each of its 20 items by comparing scores of patients injured in high impact motor vehicle accidents (MVAs) to scores of persons in a control group. In addition, we evaluated criterion and convergent validity of the PCL-5 total scores. Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) included their scores on the PCL-5, Brief Pain Inventory (BPI), Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), ratings of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire), and three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA, but all still experienced active post-MVA symptoms requiring therapy. The PCL-5 scores were also available from 21 controls (mean age 43.0 years, SD=20.3). Results and Discussion: With respect to criterion validity of the PCL-5, the post-MVA patients differed significantly from the control group not only with respect to their total PCL-5 scores, but also on all 20 individual items of the PCL-5, and also on all 4 subscales of PCL-5 (Intrusion, Avoidance, Altered Cognitions/Mood, and Arousal). The PCL-5 total scores correlated significantly to all three measures of post-MVA driving anxiety, post-MVA pain and insomnia, post-MVA depression, anger, and generalized anxiety, and to post-MVA subjective neuropsychological symptoms in the post-concussion and whiplash spectrum. Conclusions: Both the criterion and convergent validity of the PCL-5 for the use on post-MVA patients are excellent.