Making the road less rocky

Title : Making the road less rocky

Abstract:

This presentation reviews the psychiatric management of Persistent Symptoms After Concussion (PSAC), formerly known as post-concussion syndrome. It emphasizes the significant metabolic and inflammatory effects that may follow concussion, including changes in the cerebral metabolic rate of glucose consumption (CMRglc). The presentation begins with concussion epidemiology and the typical course of recovery. Although most people recover with rest and reduced stress, about 15% experience lingering post-concussion symptoms; in some cases, these symptoms persist because concussion disrupts neurotransmitter systems that regulate mood and cognitive function. The presentation then examines inflammatory pathophysiology, including progression to amyloid and tau release, and reviews evidence for psychiatric medications and nutraceuticals that may support mood recovery and cognitive improvement. While the exact percentage of cases that progress to PSAC is unknown, health care providers must address post-concussion symptoms, and neurologists or psychiatrists may be asked to treat associated mental health concerns. Mood-altering medications, psychotherapy, and occupational therapies may be recommended. This presentation will outline state-of-the-art treatment approaches for patients with PSAC, with a psychiatric focus on:

1. Mood dysregulation
   1. Anxiety
   2. Depression
   3. Pseudobulbar symptoms
   4. Impulsivity (Acting Out)
   5. Sleep dysregulation
2. Post-traumatic stress disorder
   1. Nightmares, anxiety, and flashbacks
   2. Fight, flight, freeze, or shutdown responses associated with vagal overload (dorsal medial vagal nucleus)
3. Cognitive impairment
   1. Executive function
   2. Attention
   3. Concentration
   4. Memory
   5. Processing speed
4. Psychosis
   1. Hallucinations
   2. Delusions
   3. Hypomanic and manic states

mTBI is often complicated by concurrent post-traumatic stress disorder. The presentation will review evidence-based therapies, including EMDR, Brainspotting, ketamine, and rTMS.
The presentation concludes by summarizing the key psychological tasks required for full recovery from Persistent Symptoms After Concussion (PSAC).

Biography:

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