Prolonged Concussion Potentially Linked to Psychiatric Disorders

Prolonged recovery from concussions may signal further psychiatric disorders in athletes, according to research presented at the American College of Sports Medicine (ACSM) Annual Meeting, held May 27-31, 2014, in Orlando, FL.

Researchers from St. Vincent Sports Performance (SVSP) and the Datalys Center for Sports Injury Research and Prevention in Indianapolis retrospectively studied 76 athletes aged 8-23 years who had sports-related concussions and had been referred to neuropsychological specialists for further evaluation after an average of 4.4 months. While the majority of concussions resolve within 7-10 days, some of athletes enrolled in the study experienced a concussion that lasted up to a year.

The majority of the study participants (73.7%) met the formal diagnostic criteria for at least one psychiatric disorder. Additionally, some of the athletes (64.3%) fulfilled the criteria for one comorbid psychiatric condition, 23.2% fulfilled it for 2, 8.9% for 3, and 3.6% for 4.

The researchers found 27 athletes had adjustment disorders, which were the most prevalent among the participants. Attention-deficit/hyperactivity disorder (ADHD) was present in 21 athletes, while 18 had anxiety disorders, 10 had learning disabilities, and 9 had depression and/or mood disorders.

Although the patients were evaluated with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) database, the test did not always reflect the patients’ underlying issues.

“In these cases, the symptoms aren’t matching up to the results of computerized testing,” Adam Shunk, PhD, HSPP, NCSP, said in a press release. “Either the athletes are still complaining of symptoms but their ImPACT results have returned to normal, or the ImPACT test shows deficits when they have no other signs or symptoms of concussion.”

Shunk said the deficits mentioned by patients that were not indicated by the ImPACT test might have resulted from a learning disability or mood disorders.

“Sometimes, people are complaining about headaches and further emotional issues, but those complains may be related to just the psychological conditions,” Vincent Nittoli, MS, LAT, ATC, of SVSP told HCPLive. “It could have nothing to do with the actual concussion itself.”

Though the study investigators did not specifically break down what sports the athletes tended to play, Nittoli estimated they came from high-impact sports, such as football.

“This is a definite area where treatment can happen quickly, and hopefully get people back to sports quicker,” said Nittoli, who added that a referral to a neuropsychologist is a physician’s best bet, since the specialist would be able to determine which symptoms result from the concussion and which are more directly tied to psychiatric disorders.